scholarly journals Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy

2015 ◽  
Vol 97 (8) ◽  
pp. 598-602 ◽  
Author(s):  
CJ McIntyre ◽  
JLY Allen ◽  
VA Constantinides ◽  
JE Jackson ◽  
NS Tolley ◽  
...  
Keyword(s):  
Cure Rate ◽  
Tertiary Referral Centre ◽  
Reoperative Surgery ◽  
Initial Surgery ◽  
Parathyroid Hormone Monitoring ◽  
Abnormal Parathyroid Gland ◽  
Persistent Hyperparathyroidism ◽  
Intraoperative Parathyroid Hormone ◽  
Rate Of Failure ◽  
Recurrent Hyperparathyroidism

Introduction Reoperative parathyroidectomy is required when there is persistent or recurrent hyperparathyroidism following the initial surgery (at least 5% of parathyroidectomies nationally). By convention, ‘persistent disease’ is defined as the situation where the patient has not been cured by the first operation. The term ‘recurrent hyperparathyroidism’ is used when the patient was confirmed to be biochemically cured for six months from the first operation but has hyperparathyroidism after this date. Reoperative surgery is associated with higher rates of postoperative complications as well as a greater rate of failure to cure. The aim of our study was to review our departmental experience of reoperative parathyroidectomy, with a view to identify patterns of disease persistence and recurrence. Methods Using a departmental database, patients were identified who had undergone reoperative parathyroidectomy between 2006 and 2014. All the pre, intra and postoperative information was documented including the operative note so as to record the location of the abnormal parathyroid gland found at reoperation. Results Almost two-thirds (63%) of patients had negative, equivocal or discordant conventional imaging so secondary investigative tools were required frequently. The majority of abnormal glands were found in eutopic locations. The most common locations for ectopic glands were intrathyroidal, mediastinal and intrathymic. A third (33%) of the patients had multigland disease and over a quarter (28%) had coexisting thyroid disease. Conclusions Persistent hyperparathyroidism represents a challenging patient subgroup for which access to all radiological modalities and intraoperative parathyroid hormone monitoring are required. Patient selection for reintervention is a key determinant in the reoperation cure rate.

scholarly journals Preoperative parathyroid harpoon localisation: a new technique helpful in reoperative patients with persistent hyperparathyroidism

2013 ◽  
Vol 95 (2) ◽  
pp. e1-e2
Author(s):  
J Gómez-Ramírez ◽  
D Tagarro ◽  
JM Bravo ◽  
E Martín-Pérez ◽  
E Larrañaga
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Conservative Surgery ◽  
New Technique ◽  
Reoperative Surgery ◽  
Abnormal Parathyroid Gland ◽  
Persistent Hyperparathyroidism ◽  
A New Technique ◽  
Ultrasonography Guidance ◽  
Inexpensive Technique

Surgery for persistent primary hyperparathyroidism remains a major challenge for surgeons and these reoperative procedures require an experienced parathyroid surgeon. The goal of reoperative surgery is to excise the abnormal parathyroid gland(s) and limit exploration to help minimise the potential complications. At least two positive and concordant localising studies should be available before reoperation because the technical difficulties in these cases make an exact localisation necessary before surgery. We describe the placement of a metallic harpoon under ultrasonography guidance as a safe, simple and inexpensive technique for localisation of the enlarged gland prior to conservative surgery.

Surgical Therapy for Familial Hyperparathyroidism

2009 ◽  
Vol 75 (7) ◽  
pp. 579-583 ◽  
Author(s):  
Jyotirmay Sharma ◽  
Collin J. Weber
Keyword(s):  
Primary Hyperparathyroidism ◽  
Cure Rate ◽  
Patient Demographics ◽  
Initial Surgery ◽  
Sestamibi Scanning ◽  
Recurrence Patterns ◽  
Sporadic Primary Hyperparathyroidism ◽  
Intraoperative Parathyroid Hormone ◽  
Familial Hyperparathyroidism

Isolated familial hyperparathyroidism (FHPT) not associated with multiple endocrine neoplasia is a rare and aggressive form of primary hyperparathyroidism. The traditional management of FHPT is a bilateral neck exploration with an increased rate of multigland hyperplasia, supernumerary glands, and recurrence. A prospective database was queried, which included 1383 consecutive parathyroidectomies between 1992 and 2008, and 28 patients with FHPT were identified. Patient demographics, pathology, intraoperative parathyroid hormone (IOPTH) kinetics, recurrence patterns, and accuracy of localization studies were analyzed. Twenty-one patients underwent bilateral neck explorations as an initial surgery, and seven patients had nine unilateral neck explorations for recurrent hyperparathyroidism. Overall cure rate was 89.2 per cent with a mean follow-up of 2.9 years (range: 6 months to 9.2 years); 64.3 per cent of patients had multigland disease. IOPTH helped identify supernumerary glands in three (12.5%) patients and accurately lateralized recurrent disease in eight of nine surgeries (88.8%). Tc-99m-Sestamibi failed to identify multigland disease in 11 patients (52.3%). FHPT has a greater prevalence of multigland disease, decreased utility of sestamibi scanning, and a higher recurrence rate than sporadic primary hyperparathyroidism. In FHPT, IOPTH is a useful adjunct in identifying additional tumors and in select cases may play a role in tumor localization.

scholarly journals Feasibility of Intraoperative Parathyroid Hormone Monitoring in Minimally Invasive Surgery

2021 ◽  
Vol 64 (7) ◽  
pp. 491-499
Author(s):  
Soo Jin Kim ◽  
Ju Hyun Yun ◽  
Sohl Park ◽  
Yu Jin Go ◽  
So Jeong Lee ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Normal Limit ◽  
Multiglandular Disease ◽  
Parathyroid Hormone Monitoring ◽  
Pet Ct ◽  
Sestamibi Scan ◽  
Abnormal Parathyroid Gland ◽  
Intraoperative Parathyroid Hormone ◽  
New Criteria ◽  
Single Lesion

Background and Objectives There has been a long debate on whether intraoperative parathyroid hormone (IOPTH) monitoring is mandatory or not in the excision of a single abnormal parathyroid gland. The aim of this study is to suggest a new criteron of IOPTH monitoring. Subjects and Method We retrospectively analyzed 31 patients who underwent parathyroidectomy from 2005 to 2019. Patients had IOPTH not measured and those with secondary hyperparathyroidism were excluded. IOPTH was measured preoperatively (EX00), at 10 minutes (EX10) and 20 minutes (EX20) after the excision and analyzed. We determined the surgery as a ‘successful excision of lesion (SEOUL)’ when it met the following criteria: criterion 1) the level of EX10 or EX20 decreased under the upper normal or under upper limit of parathyroid hormone (65 pg/mL); criterion 2) EX20 decreased below 50% of EX00 and less than 195 pg/ mL (3 times the upper normal limit); criterion 3) multiglandular disease. Results Twenty-five patients among 31 patients were included this study (M:F=8:17). Twenty- two patients were suspected of single lesion and three patients of multiple lesions on preoperative images (99mTc-sestamibi scan, neck CT, and PET-CT). IOPTH of EX00, EX10, and EX20 were 488.92±658.74, 121.36±134.73, and 92.44±111.55 pg/mL, respectively. Sixty-four percent patients (16/25) met the criterion 1. Six patients (24%) successfully excised a lesion meeting the criterion 2. Three patients had multiglandular disease, meeting the criterion 3. Conclusion Our new criteria suggest when we could stop the procedure. If the level of IOPTH does not meet the SEOUL criteria, it means that there might be more lesions.

Diminished Dose Minimally Invasive Radioguided Parathyroidectomy: A Case for Radioguidance

2007 ◽  
Vol 73 (7) ◽  
pp. 669-672 ◽  
Author(s):  
Christopher J. You ◽  
John L. Zapas
Keyword(s):  
Parathyroid Hormone ◽  
Minimally Invasive ◽  
Frozen Section ◽  
Standard Dose ◽  
Intraoperative Mapping ◽  
Parathyroid Hormone Monitoring ◽  
Frozen Section Analysis ◽  
Radioguided Parathyroidectomy ◽  
Intraoperative Parathyroid Hormone ◽  
Section Analysis

Minimally invasive radioguided parathyroidectomy (MIRP) has been established as an alternative to bilateral neck exploration (BNE) for primary hyperparathyroidism. We investigate whether a diminished dose of technetium-99m sestamibi gives similar results to the standard dose. One hundred one patients were offered MIRP or diminished-dose MIRP (ddMIRP). Patients received intravenous Tc-99m sestamibi at a dose of either 25 mCi 1.5 hours or 5 mCi 1 hour preoperatively. The procedure was terminated when the 20 per cent rule was satisfied. All tissue was confirmed to be parathyroid tissue by frozen section analysis. In addition, intraoperative parathyroid hormone levels were measured in a majority of patients. Patients who failed IOM underwent BNE. Frozen section analysis and intraoperative parathyroid hormone monitoring were also performed in the BNEs. Postoperatively, serum calcium levels were measured at 1 week and 6 months. Fifteen per cent of patients were male and 85 per cent were female. The median age was 63 years (range, 25–89 years). The first 58 patients had the standard dose of 25 mCi, whereas 43 patients had ddMIRP. Six patients (10%) failed intraoperative mapping in the MIRP group and were found to have single-gland disease. Five patients (12%) failed intraoperative mapping in the ddMIRP group. However, two patients were identified to have multigland disease making the true failure rate of intraoperative mapping 7 per cent (three patients). Median operative times for MIRP, ddMIRP, and BNE were 40 minutes, 46 minutes, and 105 minutes, respectively. The 20 per cent rule was satisfied in 96 per cent of patients undergoing MIRP and 98 per cent of patients undergoing ddMIRP. Frozen section analysis and intraoperative parathyroid hormone monitoring did not result in a change in management. Median follow up was 193 days and serum calcium levels at 6 months were normal. Diminished-dose MIRP is a feasible alternative to standard-dose MIRP without compromising surgical outcomes.

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