@article{GS157585,
author = {Tucker Bettis and Logan D. Glosser and Neil Saunders and Thomas Yamashita and Loreski Collado and Quynh Tran and Anee Jackson and Collin Weber and Jyotirmay Sharma and Snehal G. Patel},
title = {Evolution of Parathyroid Pathology Identification During Concomitant Thyroid Surgery},
journal = {Gland Surgery},
volume = {0},
number = {0},
year = {2026},
keywords = {},
abstract = {Background: Concomitant thyroid and parathyroid disease is well described, but published series usually report a single combined prevalence and do not separate the mode by which parathyroid pathology is detected at thyroid surgery. We describe the evolution of these patterns at a single academic center.Methods: Retrospective cohort study of patients undergoing thyroid surgery at Emory University from 1999 to 2025 (parent cohort, n=10,871). Patients with parathyroid pathology found at the same operation were identified by manual chart review (n=128) and reconciled against the institutional research dataset, yielding 125 patients after exclusions. Each patient was classified into a surgical-intent pathway: planned preoperative diagnosis, intraoperative discovery, or incidental pathology finding. Differences in pathway distribution across eras were evaluated descriptively and with Pearson chi-square testing. Exploratory analyses are reported in the supplement.Results: Among 125 patients (76% female; median age 60 years), the surgical-intent pathway was planned in 96 (76.8%), intraoperative discovery in 22 (17.6%), and incidental pathology finding in 7 (5.6%). The planned pathway rose from 29 of 45 cases (64%) in 1999–2009 to 31 of 32 (97%) in 2020–2025, while intraoperative or incidental findings decreased from 16 of 45 (36%) to 1 of 32 (3%). Coexisting thyroid malignancy was present in 35 of 125 patients (28%); of these, 31 (89% of thyroid neoplasms) were papillary thyroid carcinoma, median tumor size was 0.8 cm (IQR, 0.4–1.1), and 19 (54%) were T1a.Conclusions: At this institution, parathyroid pathology detected during concomitant thyroid surgery shifted from intraoperative or incidental discovery toward planned preoperative identification over a 27-year period. Most coexisting malignancies were small, low-stage papillary carcinomas. The 28% rate reflects a selected combined-operation cohort and should not be generalized to all primary hyperparathyroidism patients.},
issn = {2227-8575}, url = {https://gs.amegroups.org/article/view/157585}
}