Focused parathyroidectomy guided by intra-operative parathormone monitoring does not miss multiglandular disease in patients with sporadic primary hyperparathyroidism: A 10-year outcome

With a secure diagnosis of hyperparathyroidism, preoperative localization of abnormal glands is the initial step toward limited parathyroidectomy (LPX). We investigated whether ultrasonography in the hands of the surgeon (SUS) could improve the localization of abnormal parathyroids when sestamibi scans (MIBI) were negative or equivocal. One hundred eighty patients with sporadic primary hyperparathyroidism (SPHPT) underwent preoperative SUS and MIBI scans before LPX guided by intraoperative parathormone assay. When the sestamibi scans were negative, SUS was used to localize the parathyroid, distinguish parathyroid from thyroid tissue, and to guide the intraoperative jugular venous sampling for differential elevation of parathyroid hormone (PTH). Operative findings, intraoperative hormone dynamics, and postoperative calcium levels determined successful localization. MIBI was negative or equivocal in 36/180 (20%) patients: 1) showed no parathyroid gland in 22 patients, 2) suggested an incorrect location for the abnormal gland in 9, and 3) was insufficient in recognizing multiglandular disease in 5. In these 36 patients, the addition of SUS led to the successful identification of the abnormal tissue in 19/36 (53%). In the remaining 17 patients with negative/equivocal scans, the parathyroid could not be clearly visualized by SUS. In these patients, SUS facilitated LPX by aiding preoperative transcutaneous jugular venous sampling for differentially elevated PTH (n = 3) and identifying questionable thyroid nodule versus parathyroid tissue (n = 1). Overall, SUS was useful in 23/36 (67%) patients with nonlocalizing MIBI scans, thus improving the rate of localization from 80 per cent to 93 per cent ( P < 0.01). Surgeon-performed cervical ultrasonography improved the localization of abnormal parathyroids by MIBI scan, adding to the success of limited parathyroidectomy.

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Mild sporadic primary hyperparathyroidism: high rate of multiglandular disease is associated with lower surgical cure rate

Langenbeck s Archives of Surgery ◽

10.1007/s00423-019-01782-1 ◽

2019 ◽

Vol 404 (4) ◽

pp. 431-438 ◽

Cited By ~ 4

Author(s):

Emmanuelle Trébouet ◽

Sahar Bannani ◽

Matthieu Wargny ◽

Christophe Leux ◽

Cécile Caillard ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

High Rate ◽

Multiglandular Disease ◽

Cure Rate ◽

Surgical Cure ◽

Sporadic Primary Hyperparathyroidism

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Negative preoperative localization studies are highly predictive of multiglandular disease in sporadic primary hyperparathyroidism

Surgery ◽

10.1016/j.surg.2003.07.021 ◽

2003 ◽

Vol 134 (6) ◽

pp. 1038-1041 ◽

Cited By ~ 66

Author(s):

Frederic Sebag ◽

Johnathan G.H Hubbard ◽

Sylvie Maweja ◽

Claudia Misso ◽

Laurent Tardivet ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Preoperative Localization ◽

Multiglandular Disease ◽

Sporadic Primary Hyperparathyroidism

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Evaluation of Wisconsin and CaPTHUS Indices Usefulness for Predicting Monoglandular and Multiglandular Disease in Patients with Primary Hyperparathyroidism through the Analysis of a Single-Center Experience

International Journal of Endocrinology ◽

10.1155/2021/2040284 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Loredana De Pasquale ◽

Eleonora Lori ◽

Antonio Mario Bulfamante ◽

Giovanni Felisati ◽

Luca Castellani ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Preoperative Imaging ◽

Multiglandular Disease ◽

Single Adenoma ◽

Single Center Experience ◽

Disease Outcomes ◽

Main Challenge ◽

Intraoperative Pth ◽

Focused Parathyroidectomy ◽

Parathyroid Localization

Background. The main challenge for treating primary hyperparathyroidism (PHPT) is to understand if it is caused by a single adenoma (80–85% of the cases) or by a multiglandular disease (15–20%), both preoperatively and intraoperatively. For this reason, some preoperative scores were proposed in the literature, to perform focused parathyroidectomy, avoiding intraoperative parathormone assay (ioPTH). The most known are the CaPTHUS test and the Wisconsin index. We applied them to our experience. Methods. A retrospective cohort study on 462 patients referred for parathyroidectomy to Thyroid and Parathyroid Unit at Santi Paolo e Carlo Hospital, Milan, Italy, from 2011 to 2021. Only patients affected with benign PHPT and neck ultrasound performed at our institution were included. Both patients for whom preoperative imaging agreed with the localization of a single diseased parathyroid and those with only ultrasound or scintigraphy positive for parathyroid localization underwent Mini-Invasive Video-assisted parathyroidectomy. In all cases, ioPTH assay was performed. The conversion to bilateral neck exploration was decided based on the drop in ioPTH. CaPTHUS score and the Wisconsin index (Win) were applied to the series. CaPTHUS score ≥3 and Win index >1600, according to the original studies of the literature, were considered at high probability of monoglandular disease. Outcomes in these two groups were examined. Results. 236 patients were eligible for the study. The pathology resulted in multiglandular disease in 24 patients (10.2%). Among these, 18 (75.0%) obtained a CaPTHUS score ≥3, and 20 (83.3%) had a Win index>1600. Intraoperative PTH allowed to identify multiglandular disease in 16 of 18 cases with CaPTHUS ≥3 and in 18 of 20 cases with win >1600, who could have been lost, based only on the results of these 2 tests. Conclusion. Based on our experience, CaPTHUS test and Wisconsin index were not so useful in predicting multiglandular disease as ioPTH.

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Focused parathyroidectomy without intra-operative parathyroid hormone monitoring for primary hyperparathyroidism: results in a low-volume hospital

The Journal of Laryngology & Otology ◽

10.1017/s0022215115000651 ◽

2015 ◽

Vol 129 (8) ◽

pp. 788-794 ◽

Cited By ~ 10

Author(s):

T-L Chow ◽

C-Y Choi ◽

S-H Lam

Keyword(s):

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Vocal Fold ◽

Surgical Complication ◽

High Volume ◽

Parathyroid Hormone Monitoring ◽

Vocal Fold Palsy ◽

Focused Parathyroidectomy ◽

Sporadic Primary Hyperparathyroidism ◽

Low Volume

AbstractBackground:The role of routine intra-operative parathyroid hormone monitoring for sporadic primary hyperparathyroidism is contentious. Satisfactory results can be achieved in high-volume centres. The results of low-volume hospitals are rarely studied.Methods:A retrospective, non-comparative study was conducted. From November 2002 to October 2012, 105 patients with clinically sporadic primary hyperparathyroidism underwent focused parathyroidectomy without intra-operative parathyroid hormone monitoring. Single adenoma was localised on pre-operative ultrasonography or sestamibi scan. The cure rate, surgical complication rate and pathology findings were evaluated.Results:Most of the operations (63.8 per cent) were performed under local anaesthesia. All but two patients (98.1 per cent) were cured after surgery. There was only one case of double adenomas. No recurrent hyperparathyroidism was observed after a mean follow up of 56.9 months. Surgical complications comprised two cases (1.9 per cent) of transient vocal fold palsy and one case (1.0 per cent) of permanent vocal fold palsy. Seven patients (6.7 per cent) suffered temporary hypocalcaemia.Conclusion:Satisfactory results of focused parathyroidectomy without routine intra-operative parathyroid hormone monitoring for appropriately selected primary hyperparathyroidism cases can be attained in a low-volume hospital.

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