January - March 2010, Volume 6, Issue 1

Ursu H, Ioachim D, Munteanu L

About the guideline for diagnosis and treatment of primary hyperparathyroidism in a country with endemic goiter

Acta Endo (Buc) 2010, 6 (1): 129-138
doi: 10.4183/aeb.2010.129

Endemic goiter and primary hyperparathyroidism are two common endocrine disorders, and, consequently, they could coexist in many European countries. The prevalence of nodular goiters is increased in the patients with primary hyperparathyroidism, ranging widely between 22 to 70%, with higher prevalence in endemic goiter areas.\r\nRomania is a country having both endemic goiter and a high prevalence of vitamin D deficiency. Coexisting vitamin D deficiency is associated with more cases of symptomatic primary hyperparathyroidism or may mask a primary hyperparathyroidism, serum calcium being in the normal range.\r\nBecause of the frequent association of parathyroid adenomas with thyroid nodules, the optimal imaging combination is 99mTc-sestamibi and ultrasonography. Thyroid nodules can give false positive results at preoperative scintigraphy because they trap and retain 99mTc-sestamibi similarly as parathyroid adenomas.\r\nBilateral neck exploration (vs minimally invasive parathyroidectomy) is probably necessary in the treatment of primary hyperparathyroidism associated with nodular goiter, because nodular goiters increases the difficulty of preoperative localization of parathyroid lesion(s).

Keywords: primary hyperparathyroidism, nodular goiter, parathyroidectomy, thyroidectomy, iodine deficiency, vitamin D deficiency

Correspondence: Horea Ursu, CI Parhon Institute of Endocrinology, 34 ? 35 Aviatorilor Blvd, Bucharest, 011863, Romania, E ?mail: horeaursu@hotmail.com