Rachel P Espiritu1, Diana S Dean. 1. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA. espiritu.rachel@Mayo.edu
Abstract
OBJECTIVE: To highlight the possibility of development of thyroiditis after parathyroidectomy. METHODS: Clinical and laboratory findings in 2 cases are presented, and the relevant literature is reviewed. RESULTS: In 2 women (84 years old and 55 years old) with no history of thyroid disease in one of them and a remote history of excision of a follicular adenoma in the other, thyrotoxicosis developed a few days to a week after parathyroidectomy for primary hyperparathyroidism. The first patient underwent bilateral cervical exploration with removal of a right inferior parathyroid adenoma, whereas the second patient had excision of 3 1/2 parathyroid glands for 4-gland hyperplasia and 2 benign nodules from the left thyroid lobe. Both surgical procedures were uncomplicated. Neither patient had received any iodinated contrast agents or medications such as lithium or amiodarone before presentation. Laboratory results showed elevated levels of free thyroxine, suppressed thyroid-stimulating hormone levels, very low radioiodine uptake (in the second patient), and an elevated thyroglobulin level (in the first patient). Both patients were treated symptomatically with beta-adrenergic antagonists. Thyroid function normalized and symptoms diminished after 1 to 2 months. CONCLUSION: Parathyroidectomy-induced thyroiditis is underrecognized. The majority of patients are asymptomatic, although clinically significant thyrotoxicosis can also occur. Candidates for parathyroidectomy should be informed of this potential complication, and thyroid function should be assessed if clinically indicated.
OBJECTIVE: To highlight the possibility of development of thyroiditis after parathyroidectomy. METHODS: Clinical and laboratory findings in 2 cases are presented, and the relevant literature is reviewed. RESULTS: In 2 women (84 years old and 55 years old) with no history of thyroid disease in one of them and a remote history of excision of a follicular adenoma in the other, thyrotoxicosis developed a few days to a week after parathyroidectomy for primary hyperparathyroidism. The first patient underwent bilateral cervical exploration with removal of a right inferior parathyroid adenoma, whereas the second patient had excision of 3 1/2 parathyroid glands for 4-gland hyperplasia and 2 benign nodules from the left thyroid lobe. Both surgical procedures were uncomplicated. Neither patient had received any iodinated contrast agents or medications such as lithium or amiodarone before presentation. Laboratory results showed elevated levels of free thyroxine, suppressed thyroid-stimulating hormone levels, very low radioiodine uptake (in the second patient), and an elevated thyroglobulin level (in the first patient). Both patients were treated symptomatically with beta-adrenergic antagonists. Thyroid function normalized and symptoms diminished after 1 to 2 months. CONCLUSION: Parathyroidectomy-induced thyroiditis is underrecognized. The majority of patients are asymptomatic, although clinically significant thyrotoxicosis can also occur. Candidates for parathyroidectomy should be informed of this potential complication, and thyroid function should be assessed if clinically indicated.