Biomedical subjects

I B Rosen

Publications and source records attributed to I B Rosen.

At least 19 recordsLinked to original sources

PubMed1995

Secondary malignancy of the thyroid gland and its management.

BACKGROUND: Secondary cancer of the thyroid gland is widely acknowledged as infrequent but is a persistent problem requiring ongoing awareness, particularly with respect to clinical recognition and treatment. METHODS: From 1978 to 1993, a 15-year period, patients demonstrating secondary involvement of the thyroid gland as a surgical problem were collected and analyzed with regard to pathology, demography, behavior of primary and secondary disease, treatment, and patient outcome. RESULTS: In the 15-year span, 11 patients with secondary involvement of the thyroid gland were recognized, consisting of 3 men and 8 women with primary lesions occurring in oral cavity, esophagus, stomach, colon, pancreas, breast, skin, unknown, kidney, and lung. Needle biopsy produced a 90% malignancy rate but in only half of such cases was the diagnosis specific for secondary malignancy. Eight of 11 underwent palliative surgery, usually total thyroidectomy. No patient survived > 2 years. There was no undue surgical morbidity. One patient died of pulmonary embolus postoperatively. CONCLUSIONS: Secondary cancer of the thyroid is rare and can be detected by fine-needle aspiration biopsy in the face of clinical findings. Where indicated, palliative thyroidectomy can be effective, because other methods of treatment appear ineffective.

Aged↗

PubMed1995

Management of the hot thyroid nodule.

BACKGROUND: Solitary hyperfunctioning nodules of the thyroid gland are usually viewed as benign. They may present with autonomous euthyroidism but are of concern for potential progression to hyperthyroidism. Various methods of treatment are worthy of consideration. PATIENTS AND METHODS: Forty-five patients with solitary hot thyroid nodules verified by radioisotope scintiscanning were selected for treatment. Thirty-one underwent surgery, usually partial thyroidectomy. Eight euthyroid patients received no treatment, 5 underwent therapy with radioactive iodine (RAI), and 1 received thyroid suppression treatment. The cases were assessed retrospectively. RESULTS: Thyroidectomy patients had no morbidity, were well, and showed 1 Hürthle cell tumor and 5 coincidental small malignancies associated with benign hot nodules, including a contralateral cancer. Untreated patients showed continuance of good health, but nodules persisted and 1 Graves' orbititis occurred. The RAI-treated patients had persistent nodularity, improved function, and 1 case of hyperparathyroidism. Thyroid feeding only caused iatrogenic toxicity and was discontinued. CONCLUSIONS: There are various techniques for managing the hot nodule. Nonsurgical methods may be effective, but can result in persistent nodularity and iatrogenic sequelae. Excision had no morbidity in this series and was effective in providing immediate relief of problems present and potential.

Adenocarcinoma↗

PubMed1995

Management considerations in Hürthle cell carcinoma.

BACKGROUND: Hürthle cell tumors still pose issues concerning diagnosis and management. METHODS: From 1984 to 1993 forty-seven patients underwent thyroidectomy, and they were diagnosed after operation to have presumptive Hürthle cell tumors. The surgical pathologic findings were reviewed. In the neoplastic group the chart was reviewed for clinical features and outcome. RESULTS: Thirty-one patients had nonneoplastic Hürthle cell nodules. Eleven (69%) of the 16 tumors were malignant affecting 11 women and five men ranging in age from 22 to 86 years. Two patients died of cancer for a 18% rate; one patient is alive with disease. Operations were uncomplicated. Factors for adverse outcome include tumor size greater than 4 cm, woman older than 60 years of age, and complete capsular invasion on surgical pathologic findings. CONCLUSIONS: Fine-needle aspiration biopsy demonstration of Hürthle cell lesion is an indication for operation, providing Hashimoto's thyroiditis is excluded. Our surgical practice (I.B.R.) is to perform total thyroidectomy for all Hürthle cell neoplasms, as well as jugular node sampling and adjuvant radioiodine for cancer. Stringent histologic interpretation is possible and necessary for true appreciation of Hürthle cell tumor incidence and behavior. Cancer mortality of 18% is greater than the rate (2%) of our well-differentiated thyroid cancer group.

Adenoma, Oxyphilic↗

PubMed1995

Congenital thyroid hemiagenesis.

Failure of embryologic development of a lobe of the thyroid gland is a rare anomaly. In order to characterize this unusual entity, we report our experience in seven patients with thyroid hemiagenesis involving the left lobe in five and the right lobe in two patients. The diagnosis was made as a result of evaluation and treatment of a thyroid nodule (4), diffuse thyroid enlargement with thyrotoxicosis (2), and a simple goiter in a patient with a prior history of radiation treatment for facial acne. In five patients thyroid scintigraphy demonstrated unilateral absence of function, four of whom had an ultrasound exam of the neck that revealed a corresponding absence of thyroid tissue. In one patient the diagnosis was made incidentally on a screening ultrasound exam of the neck. Thyroid hemiagenesis was unsuspected preoperatively in one patient with Graves' disease because of marked hyperplasia of a single thyroid lobe and isthmus. Thyroid hemiagenesis was confirmed in four patients who underwent thyroidectomy. The presence of a thyroid isthmus was established in six patients. Postoperatively, all patients were treated with thyroid hormone. Associated thyroid pathology included adenoma (1), follicular carcinoma (1), colloid nodule (2), Graves' disease (2), and a simple goiter (1). In conclusion, the diagnosis of thyroid hemiagenesis should be considered in any patient with unilateral absence of function on thyroid scintigraphy and confirmed by ultrasonography. Recognition of this rare congenital anomaly is important to avoid unnecessary contralateral neck exploration with its potential morbidity and to insure that all patients receive careful follow-up and appropriate thyroid hormone therapy when necessary.

Adenocarcinoma, Follicular↗

PubMed1994

The through-and-through oromandibular defect: rationale for aggressive reconstruction.

Through-and-through oral cancer (T4+) involving contiguous mucosa, mandible, and skin is a devastating disease with poor prognosis and represents one of the most difficult reconstructive challenges in head and neck surgery. Thirty-eight patients underwent immediate microvascular reconstruction following surgical tumor ablation. The purpose of the present review was to assess the value of microvascular reconstruction in these essentially palliative reconstructive efforts. The iliac crest osteocutaneous flap was used in the majority of patients and was found to be ideal for the reconstruction of large bony and soft-tissue defects present in this group of patients. Other methods, including pectoralis major, forehead, and latissimus dorsi flaps, also were used in the soft-tissue reconstruction. The mean follow-up was 16 +/- 2 months, and the mean hospitalization was 43 +/- 22 days. The majority of patients succumbed to recurrent or related diseases, yet a few went on to survival despite the initial advanced stage of disease. A number of complications were observed. However, most patients developed normal or easily intelligible speech (65 percent), and most (78 percent) had their tracheostomies closed and sustained themselves on an oral soft diet (84 percent). Bony union was noted in the majority of patients (73 percent). Although the prognosis in full-thickness oral carcinoma is grim, it appears that palliative surgery in these cases is well justified. The goals are to shorten the duration of hospitalization, reduce morbidity, and improve the remaining quality of life. Microvascular tissue transfer offers a means to achieve these goals in a single, reliable procedure. We feel that immediate one-stage bone and soft-tissue reconstruction restores dignity and relieves suffering in this unfortunate group of individuals.

Adult↗

PubMed1994

Parathyroid cancer: clinical variations and relationship to autotransplantation.

OBJECTIVE: To identify the clinical and pathological characteristics of parathyroid cancer to determine the best method of treatment and to prevent the use of malignant tissue for autotransplantation. DESIGN: A chart review over a 20-year period (1973 to 1993). SETTING: Two tertiary-care referral centres in Ontario with specialty interest in disease of the thyroid and parathyroid glands. PATIENTS: Sixteen patients, identified as has having parathyroid cancer (equivocal diagnosis in 9 and definitive diagnosis in 7). MAIN OUTCOME MEASURES: The clinical and histologic features, treatment, morbidity and mortality of parathyroid cancer. RESULTS: Some patients with an equivocal diagnosis had postoperative recurrent hyperparathyroidism characterized by multiple soft-tissue implants of parathyroid that persisted after reoperation. The others had infiltrative attachment of parathyroid lesions to the thyroid gland and were eucalcemic and disease free up to 12 years after treatment. Three of the seven patients with a definitive diagnosis of parathyroid cancer were treated for a neck mass; the others were treated for hypercalcemia and multiple lytic bone lesions, hypercalcemia and renal disease and secondary hyperparathyroidism. En-bloc resection, carried out in all but one case, was curative in five cases. The patient with secondary hyperparathyroidism underwent total parathyroidectomy and autotransplantation but died of metastatic parathyroid cancer 1 year later. CONCLUSIONS: Because of the difficulty in making a histologic diagnosis of parathyroid cancer, en-bloc resection of the thyroid and parathyroid glands and locally invaded structures is the appropriate treatment to avoid tumour spillage. Caution should be exercised in the use of donor parathyroid tissue for autotransplantation.

Adenoma↗

PubMed1993

Ultrasound-guided fine-needle aspiration biopsy in the management of thyroid disease.

During a 23-month period, 59 patients were referred for ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) of the thyroid gland because of inadequate orthodox (office) FNAB, a clinically small lesion, or an occult lesion. Seventy percent of the group (41 patients) was referred for surgery, which revealed cancer in 37% of patients, adenoma in 19%, and benign disease in 44%. US-guided FNAB yielded false-positive reports in 0% of patients, false-negative reports in 5% to 12%, and inadequate aspirates in 32%. The US-guided FNAB technique had a sensitivity of 60% to 90%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 80%, and an accuracy of 85%. US-guided FNAB provides cytologic information in 60% of patients in whom a diagnosis cannot be established by orthodox (office) means, thus enhancing the diagnostic ability of clinicians who can recommend a treatment program with confidence.

Adenoma↗

PubMed1993

Influence of fine-needle aspiration biopsy and frozen section examination on the management of thyroid cancer.

In order to delineate the influence of fine-needle aspiration biopsy (FNAB) and frozen section examination (FS) on the management of patients with thyroid cancer, a review of 310 patients with thyroid cancer, seen in follow-up during a 3-year period, was completed. Combined FNAB and FS examination were assessed in 225 patients, 172 (76%) with papillary carcinoma, 36 (16%) with follicular carcinoma, 13 (6%) with Hürthle cell carcinoma, and 4 (2%) with medullary carcinoma. The diagnosis according to FNAB was malignant in 78 patients (35%), cellular in 135 (60%), and benign in 12 (5%). All 78 patients with a malignant FNAB diagnosis had papillary cancer. The results of FS examination correlated with the FNAB findings in 74 patients (95%), whereas 4 patients (5%) had a false-negative FS diagnosis of "adenoma." Of the 135 patients with a cellular FNAB diagnosis, FS examination showed cancer in 75 (56%): 58 with papillary carcinoma, 7 with follicular carcinoma, and 10 with Hürthle cell carcinoma. Sixty patients (44%), 30 with papillary carcinoma, 27 with follicular carcinoma, and 3 with Hürthle cell carcinoma, had a cellular FNAB diagnosis and a FS diagnosis of a follicular neoplasm. Twelve patients (5%), 6 with papillary carcinoma, 4 with medullary carcinoma, and 2 with follicular carcinoma, had both false-negative FNAB and FS. From these results, we conclude that FS examination is indicated for intraoperative decision-making in patients with a cellular FNAB diagnosis but is unnecessary when the FNAB diagnosis is either benign or malignant. In order to avoid possible reoperation, near-total thyroidectomy should be presented as an alternative for the treatment of a hypofunctioning thyroid nodule when both FNAB and FS results are consistent with "follicular neoplasm."

Adenocarcinoma↗

PubMed1993

Non-diagnostic fine needle aspiration biopsy: a dilemma in management of nodular thyroid disease.

The implications of a persistent "non-diagnostic" fine needle aspiration biopsy (FNAB) has yet to be defined in patients with a solitary thyroid nodule. Four hundred and eleven patients from 1986 to 1990 with a solitary cold thyroid nodule underwent thyroidectomy, including 92 with a "non-diagnostic" FNAB, despite a minimum of two repeat samples. Pathology revealed cancer in eight (9%)--six papillary, one lymphoma, and one squamous cell--follicular adenoma in 38 (41%), Hurthle cell adenoma in two (2%), colloid nodule in 41 (45%), epithelial cyst in two (2%), and thyroiditis in one patient (1%). The operation was uncomplicated by hypoparathyroidism or nerve dysfunction. Age, sex, nodule size, and a history of neck irradiation were examined as possible predictors of cancer risk. Male sex, previous neck irradiation and larger nodules were more common among thyroid cancer patients, but only male sex was statistically significant (P < 0.05). Persistent "nondiagnostic" cytology is a significant limitation of FNAB associated with a 52% neoplasia rate and a 9% incidence of malignancy. "Non-diagnostic" FNAB should be repeated and, if necessary, performed under ultrasound guidance. In order to avoid a missed carcinoma, surgical treatment of persistent "non-diagnostic" FNAB in a dominant hypofunctioning nodule is indicated for the male patient, radiation-associated nodular thyroid disease, recurrent cysts, compression symptoms, and failure of a 6-month trial of thyroid suppression. Lack of needle biopsy and operative morbidity justifies the aggressive exclusion of cancer.

Adolescent↗

PubMed1992

Postparathyroidectomy transient thyrotoxicosis.

Three patients are described who had spontaneously resolving transient thyrotoxicosis after resection of a parathyroid adenoma without thyroidectomy or an apparent thyroid abnormality before or during surgery. All had documented thyrotoxicosis that developed within 2 weeks after surgery, which was clinically symptomatic in two of three patients. The thyrotoxicosis was associated with subnormal radioactive iodine thyroid uptake when performed in the two symptomatic patients and was consistent with a postsurgical inflammatory etiology secondary to thyroid gland trauma during parathyroidectomy. In all patients, the clinical and biochemical evidence of thyrotoxicosis resolved within 2 months. Antithyroglobulin and antimicrosomal antibodies were not detected in the two patients who had a complete recovery 3 months after surgery. However, in the patient who had autoimmune thyroiditis, hyperthyroidism due to Graves' disease subsequently developed 19 months after parathyroidectomy and was associated with increasing titers of antithyroglobulin and antimicrosomal thyroidal autoantibodies. From these observations, we conclude that 1) spontaneously resolving transient thyrotoxicosis of varying severity may occur in some patients after parathyroidectomy, which could be secondary to intraoperative thyroid gland manipulation, and 2) while the occurrence of subsequent Graves' hyperthyroidism in a patient with underlying autoimmune thyroiditis may have been a coincidence, this observation also raises the possibility that thyroidal autoantigen released during parathyroidectomy may trigger the reactivation of autoimmune thyroid disease in a predisposed subject.

Adolescent↗

PubMed1992

Surgical treatment in non-neoplastic parotid disease: indications and results.

Non-neoplastic disease of the parotid gland is an important entity, requiring differential diagnosis and management. The incidence of non-neoplastic parotid disease (NNPD) is increasing and makes up about 25% of cases for which parotidectomy is indicated. NNPD can be categorized as type I (asymptomatic soft diffuse enlargement or circumscribed firm nodular enlargement) or type II (inflammatory lesions with recurrent pain and swelling, obstructive or nonobstructive). Concern over possible malignancy is highest in type I nodular lesions and least in type II lesions. Operative treatment may be indicated for exclusion of tumour, relief of recurrent pain and swelling and patient anxiety. In 62 patients with NNPD who were operated on, the relevant clinical factors included radiation, diabetes, tuberculosis, Sjögren's syndrome and pulmonary sarcoidosis. Superficial parotidectomy was effective, being associated with low morbidity, and can be recommended as acceptable treatment, providing there is a complete patient history and operation is carried out by a surgeon experienced in parotid surgery.

Adolescent↗

PubMed1991

Prospective management of nodal metastases in differentiated thyroid cancer.

Previous studies have concluded that lymph node metastases do not affect survival rates in patients with differentiated thyroid carcinoma and, therefore, nodal metastasis has not been evaluated as a prognostic factor in recent definitions of risk groups. To determine the significance of nodal disease, we reviewed 227 consecutive patients with differentiated thyroid carcinoma (173 with papillary, 37 with follicular, and 17 with Hürthle cell carcinoma). Of 70 (31%) patients with lymph node metastases (14 [20%] palpable preoperatively and 56 [80%] detected by routine sampling of middle and lower cervical nodes), 13 (19%) developed a recurrence compared with only 3 of 157 (2%) without nodal disease (p less than 0.01). Sixty-eight patients were treated with modified neck dissection, 63 of whom received adjuvant radioiodine. There were 10 recurrences in 63 patients (16%) who had been treated with radioiodine, compared with 3 recurrences in 7 (42%) patients who did not receive adjuvant radioiodine. Follow-up ranged from 2 to 28 years, with a mean of 8 years. Involvement of the lymph nodes was a marker for systemic disease occurring synchronously in 4 of 5 patients who presented with distant metastases and preceding systemic recurrence in 9 of 10 patients. Four patients (2%), all with lymph node metastases (three with concomitant extrathyroidal invasion and one with systemic metastases at initial presentation), died of thyroid carcinoma. Cervical lymph node metastases were associated with a higher incidence of recurrence and occurred synchronously or preceded the development of distant metastases in 13 of 15 (87%) patients. Although these findings were not statistically significant for overall survival, they lend support to routine cervical lymph node sampling for detection of and modified neck dissection with adjuvant radioiodine therapy for treatment of lymph node metastases. Such measures should reduce the subsequent recurrence rate and permit early detection and treatment of systemic disease.

Adult↗

PubMed1991

Relevance of vitamin D metabolite concentrations in supporting the diagnosis of primary hyperparathyroidism.

We compared the relationships between 25-hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)2D] levels in patients with primary hyperparathyroidism (PHPT) and 38 volunteer blood donors. There was no significant difference in mean 25(OH)D levels between patients with PHPT (34 +/- 21 nmol/L; n = 21) and the donor samples (41 +/- 19 nmol/L; n = 38). Serum 1,25(OH)2D levels were higher in the patients with PHPT compared with the donors (122 +/- 61 pmol/L vs 56 +/- 41 pmol/L; p less than 0.001). The 95th percentile 1,25(OH)2D value for the donors was exceeded in 65% of the patients with PHPT. There was a significant correlation between serum 1,25(OH)2D versus 25(OH)D in the patients with PHPT (r = 0.50; p less than 0.05) but not in the donors (r = 0.02). We conclude from the distinct elevation in 1,25(OH)2D levels in the majority of our patients with PHPT that the concentration of this parathyroid hormone-dependent hormone can be of critical value in corroborating the diagnosis of PHPT.

Adult↗

PubMed1990

Oral calcium load test: diagnostic and physiologic implications in hyperparathyroidism.

An oral calcium load test (CLT) (1 gm Ca/50 kg) was administered to 11 control subjects and 35 patients with overt hyperparathyroidism to assess its efficacy in diagnosis of hyperparathyroidism. All participants were placed on a low-calcium diet 3 days before the CLT. Intact parathormone and ionized calcium (Cai) levels were measured 0, 1, 2, and 3 hours after CLT. Initial Cai and parathormone (mean +/- SE) were 1.22 +/- 0.01 mmol/L and 2.94 +/- 0.03 pmol/L in the control group compared with 1.43 +/- 0.02 mmol/L and 10.6 +/- 2.2 pmol/L in the group with hyperparathyroidism. Both groups had a similar percent increase in Cai values (control, 5.9% +/- 0.8%; hyperparathyroidism, 6.3% +/- 0.6% (p greater than 0.1). A decline in parathormone levels of 47.6% +/- 2.8% in patients with hyperparathyroidism was significantly less than the 75.3% +/- 5.3% decline observed in control subjects (p less than 0.025). Three hours after CLT, parathormone was suppressed in control subjects, whereas a rebound occurred in patients with hyperparathyroidism. Postoperative CLT demonstrated a higher mean percent Cai increase and percent parathormone decline (Cai, 8.9% +/- 1.1%; parathormone, 67.9% +/- 1.8%) compared with preoperative values (Cai, 6.0% +/- 1.0%; PTH, 49.6% +/- 4.3%) (p less than 0.025), and 3 hours after calcium intake, parathormone remained suppressed, similar to control subjects. After surgery, three patients had elevated parathormone and low normal Cai levels and parathormone response to a CLT confirmed the diagnosis of secondary hyperparathyroidism. In conclusion, a CLT (1) can confirm the diagnosis of hyperparathyroidism and successful parathyroidectomy, (2) distinguished postoperative secondary from persistent primary hyperparathyroidism, (3) demonstrated nonautonomy of abnormal parathyroid glands with a parathormone response to a calcium load characterized by an earlier nadir, decreased suppressibility, and more rapid recovery, and (4) produced dynamic changes that did not distinguish patients with hyperparathyroidism from control subjects or hyperplasia from adenoma.

Administration, Oral↗

PubMed1990

Intraoperative parathormone level measurement in the management of hyperparathyroidism.

To investigate the potential use of intraoperative intact parathormone measurements to predict curative parathyroidectomy, we measured ionized calcium (Cai) levels and parathormone levels in 33 patients with hyperparathyroidism who underwent exploratory bilateral neck surgery. Nineteen patients each had a solitary adenoma, 13 patients had hyperplasia, and one patient had four normal parathyroid glands. These results were compared to the results for 37 patients who underwent either thyroid lobectomy (TL) (n = 10) or near-total thyroidectomy (NTT) (n = 27) and of 14 control patients who underwent miscellaneous operations. Parathormone decline after curative parathyroidectomy was 86.4 +/- 1.2% (mean +/- SE), which was significantly greater than a decline of 25.7% +/- 9.8% in three patients with persistent postoperative hyperparathyroidism (p less than 0.01). Declines were 38.5% +/- 8.7% after TL (p less than 0.01), 52.2% +/- 5.9% after NTT (p less than 0.01), and 8.3% +/- 4.3% (p less than 0.01), in the control patients. An intraoperative Cai decline of 4.0% +/- 0.6% after curative parathyroidectomy did not differ significantly from the results after TL, NTT, or miscellaneous operations in the control patients. Patients with persistent postoperative hyperparathyroidism had the greatest decline in Cai levels (7.1% +/- 2.3%; p less than 0.05). From these data we conclude that (1) a decline in parathormone level of 70% or more 20 minutes after parathyroidectomy is predictive of cure, (2) thyroidectomy, even unilaterally, produces a significant decline in parathormone level that affects interpretation of intraoperative parathormone level changes, (3) Cai level because of its slow decline is not useful in predicting effective parathyroidectomy, and (4) measurement of intraoperative parathormone level changes should not be used as a substitute for exploratory bilateral neck surgery.

Adult↗

PubMed1990

Lithiumogenic disorders of the thyroid and parathyroid glands as surgical disease.

Little notice has been paid in the surgical literature to problems with psychoeffective lithium, which by interfering with adenylate cyclase affects thyroid and parathyroid function, causing hypercalcemia, hyperparathyroidism, and hypothyroidism. Seven patients with lithiumogenic hyperparathyroidism occurring after years of lithium therapy underwent treatment and manifested osteoporosis (n = 2), hypertension (n = 2), nephrolithiasis (n = 1), coma (n = 1), rising hypercalcemia (n = 1), goitrous myxedema (n = 4), nephrogenic diabetes insipidus (n = 2), renal failure (n = 2), and hyperlipidemia (n = 1). Disease-directed parathyroidectomy (without morbidity) was curative. Unique laboratory findings included normal serum phosphorus and reduced urinary calcium and cyclic adenosine monophosphate values. Three separate cases of thyroid carcinoma after long-term lithium therapy were also treated, being preceded by myxedema (n = 2) and concurrent with hyperparathyroidism (n = 1). There has been only one previous report of lithium-associated thyroid carcinoma. All patients taking lithium should undergo surveillance for thyroid and parathyroid dysfunction and neoplasia, and appropriate surgical and medical treatment should be considered in each situation. Although hyperparathyroidism may be reversible with lithium discontinuance, such therapy may be obligatory for patient well-being, thus dictating parathyroidectomy.

Adult↗

PubMed1989

Speaking jejunum after laryngopharyngectomy with neoglottic and neopharyngeal reconstruction.

Total laryngopharyngectomy results in a considerable degree of morbidity. Although many advances have been made over the past 10 years, the restoration of speech remains an unsolved problem. Herein, we present three patients who underwent both neoglottic and neopharyngeal reconstruction using a free vascularized segment of jejunum. All three patients were able to swallow and two were able to speak. We believe that this method of reconstruction restores speech after total laryngopharyngectomy.

Deglutition↗

PubMed1989

Do we really need another localizing technique for parathyroid glands?

To evaluate magnetic resonance imaging (MRI) in the preoperative localization of abnormal parathyroid glands, we examined 16 patients with primary hyperparathyroidism at initial presentation with MRI and ultrasound of the neck. These studies were analyzed prospectively and compared with the findings at bilateral neck exploration. The surgeon was intentionally blinded to the imaging studies. MRI was accurate in the lateralizing of an abnormal gland in 21 of 32 sides (66 percent). Sensitivity was 65 percent and specificity was 66 percent. Ultrasound was accurate in 19 of 32 sides (59 percent). Sensitivity was 50 percent and specificity was 75 percent. The difference was not statistically significant. We do not believe that MRI is indicated prior to initial exploration in patients with primary hyperparathyroidism.

Humans↗