Unexpected findings during thyroid surgery in a regional community hospital : A 5-year experience of 738 consecutive cases. Discussion

Unexpected findings during thyroid surgery in a nonuniversity setting have rarely been reported in large series. Our goal was to describe the unexpected findings during thyroid surgery in a busy regional community hospital. All thyroid operations conducted by the teaching staff at Greenville Memoria...

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Published inThe American surgeon Vol. 71; no. 11; pp. 911 - 915
Main Authors LOKEY, Jonathan S, PALMER, Robert M, MACFIE, Jefferys A, SCHENK, Worthington G, FELICIANO, David V
Format Conference Proceeding Journal Article
LanguageEnglish
Published Atlanta, GA Southeastern Surgical Congress 01.11.2005
SAGE PUBLICATIONS, INC
Subjects
Biological and medical sciences
General aspects
Hospital systems
Medical diagnosis
Medical sciences
Surgery
Thyroid gland
Medicine
Treatment
Surgery
Thyroid gland
Hospital
Regional
Discussion
Community
Public health
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Summary:Unexpected findings during thyroid surgery in a nonuniversity setting have rarely been reported in large series. Our goal was to describe the unexpected findings during thyroid surgery in a busy regional community hospital. All thyroid operations conducted by the teaching staff at Greenville Memorial Hospital, a 735-bed nonuniversity regional hospital, from December 1998 through December 2003 were reviewed. Pre- and post-operative diagnoses, surgical procedure, and specimen histopathology were examined. Unexpected findings were defined as either thyroid pathology not anticipated based on preoperative diagnosis or as unsuspected nonthyroidal disease found during cervicotomy. During the 5-year study period, 738 patients presented with thyroid disease requiring surgery. Incidental thyroid cancer was discovered in 28 cases (3.8%), the predominance being papillary microcarcinoma. Synchronous benign thyroid disease, separate from the indication from surgery, was observed in 56 patients (7.6%). Forty patients had unexpected nodular goiter and 16 had lymphocytic thyroiditis. Primary hyperparathyroidism was observed in 33 patients (4.5%). Both solitary adenomas (22 cases) and multigland parathyroid disease (11 cases) were seen. Unexpected nonendocrine findings were less common, including solitary cases of large cell carcinoma, metastatic endometrial carcinoma, and tracheal duplication (bronchogenic cyst). In conclusion, unexpected findings during thyroid surgery at a busy community hospital are fairly common. Indeed, an unanticipated finding is encountered in one out of seven operations on the thyroid gland. Although most are of unclear clinical significance, there is a surprisingly high incidence of hyperparathyroidism. This underscores the need for preoperative screening, as the "thyroid patient" may also be the "parathyroid patient." [PUBLICATION ABSTRACT]
ISSN:0003-1348
1555-9823