SURGICAL ANATOMY OF PARATHYROID GLANDS IN PATIENTS WITH SECONDARY HYPERPARATHYROIDISM

Ectopic or supernumerary parathyroid glands (PTg) can be the reason of surgical failure in treat- ment of secondary hyperparathyroidism in patients, who underwent dialysis. The aim of this study is to estimate the number and localization of PTgs in patients with secondary hyperparathyroidism. We included 165 patients, who underwent total parathyroidectomy with heterotopic autotransplantation of parathyroid gland tissue or subtotal parathyroidectomy. All identified PTgs were separated in two groups: eutopic and ectopic. Preoperative localization was performed by multispiral computed tomog- raphy of neck and mediastinum, neck ultrasonography, two-isotope Tc99 MIBI of PTgs. In postopera- tive period, we estimated the level of parathyroid hormone in the serum and performed morphological verification. There were found 659 PTgs. 12 (7,2%) patients had 3 parathyroid glands, and 11 (6.7%)had 5 PTgs. 4 Ptgs were found in 142 (86,1%) patients. 520 (78,9%) PTgs were eutopic, 139 (21,1%) - ectopic. The most common ectopic place for upper PTgs were paraesophageal and retrotracheal spaces, carotid sheath. Ectopic lower PTgs were most commonly located in the horns of the thymus. All super- numerary PTg were ectopic and often located in area between lower pole of the thyroid lobe and the thymus.Conclusion. During the operation in case when ectopy is suspected, upper PTgs should be located in in paraesophageal and paratracheal areas or in carotid sheath, if it necessary. If lower PTgs is absence, surgery should be completed cervical thymectomy.

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Surgical treatment of patients with secondary hyperparathyroidism in chronic renal failure

Problems of Endocrinology ◽

10.14341/probl11761 ◽

2003 ◽

Vol 49 (6) ◽

pp. 36-41

Author(s):

V. N. Smorshchok ◽

N. S. Kuznetsov ◽

A. M. Artemova ◽

L. Ya. Rozhinskaya ◽

D. G. Beltsevich

Keyword(s):

Parathyroid Hormone ◽

Surgical Treatment ◽

Secondary Hyperparathyroidism ◽

Clinical Laboratory ◽

Intraoperative Ultrasound ◽

Parathyroid Glands ◽

Total Parathyroidectomy ◽

Subtotal Parathyroidectomy ◽

Ultrasound Study ◽

Made In

The purpose of the study was to define indications for surgical treatment and its scope in patients with secondary hyperparathyroidism in the presence of end-stage chronic renalfailure. The authors examined 80 patients who had a history of long-term procedures of hemo- or peritoneal dialysis. The patients’ mean age was 47±3.2 years. Measurements of the levels of alkaline phosphatase, ionized and total calcium, phosphorus, parathyroid hormone, ultrasound of the parathyroid glands, densitometry and X-ray study were made in all the patients. All the patients received alfacalcidole therapy during different periods of time. Clinical, laboratory, and morphological correlations were made to establish indications for surgical treatment. The sensitivity ofpreoperative ultrasonography was 72.5% and that of intraoperative ultrasound study was as high as 98.4%. The sensitivity of intraoperative revision was 75%. Sixteen of the 20 patients operated on underwent total parathyroidectomy by autografting a fragment of one of the least glands into the muscle. Subtotal parathyroidectomy was made in 3 patients; 3 parathyroid glands were removed in 1. Emergency and planned studies were performed in all the patients. The duration of the patients operated on averaged 14 months. Three patients undergone total parathyroidectomy with autografiing developed signs of hyperparathyroidism following 6, 12, and 13 months, in this connection graft resection was made in these patients. In the follow-up periods of 3 to 6 months, the level of parathyroid hormone became normal after resurgery in 2 of these patients, hypoparathyroidism developed in one patient. Two months after surgery, recurrent secondary hyperthyroidism was detected in 2 of the 3 patients who had undergone subtotal parathyroidectomy (4 and 7 months after the occurrence of signs of transient hypoparathyroidism) and in 1 patient in whom 3 parathyroid glands had been removed. Four of the 20 patients operated on were observed to have hypoparathyroidism that was compensated by calcium preparations and active forms of vitamin D3. Thus, a good result was noted in 70% of the patients after surgical treatment.

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Corrigendum to “Quality of life after surgery in secondary hyperparathyroidism comparing subtotal parathyroidectomy to total parathyroidectomy with immediate parathyroid autograft – a prospective randomized trial” [Surgery 164 (2018) 978-985]

Surgery ◽

10.1016/j.surg.2018.11.010 ◽

2019 ◽

Vol 165 (2) ◽

pp. 497

Author(s):

Wellington Alves Filho ◽

Willemijn Y. van der Plas ◽

Marilia D.G. Brescia ◽

Climerio P. Nascimento ◽

Patricia T. Goldenstein ◽

...

Keyword(s):

Quality Of Life ◽

Secondary Hyperparathyroidism ◽

Randomized Trial ◽

Prospective Randomized Trial ◽

Total Parathyroidectomy ◽

Subtotal Parathyroidectomy

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Secondary Hyperparathyroidism

10.2310/7800.16040 ◽

2019 ◽

Author(s):

Anna C Beck ◽

Sonia L Sugg

Keyword(s):

Renal Failure ◽

Chronic Renal Failure ◽

Secondary Hyperparathyroidism ◽

Total Parathyroidectomy ◽

Indications For Surgery ◽

Subtotal Parathyroidectomy ◽

Diagnostic Work ◽

Work Up ◽

Hungry Bone ◽

Diagnostic Work Up

Secondary hyperparathyroidism is defined and its pathophysiology, delineated. Key components of the diagnostic work-up, medical management, and indications for surgery are described. The operative approach and controversy on extent of parathyroidectomy are discussed. This review contains 3 figures, 1 tables, and 24 references. Key Words: autotransplantation, calciphylaxis, chronic renal failure, cryopreservation, hungry bone syndrome, hypocalcemia, secondary hyperparathyroidism, subtotal parathyroidectomy, total parathyroidectomy

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