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Journal of Visualized Experiments : JoVE Aug 2022Parathyroid gland (PG) identification is a critical unmet need in thyroidectomy. The identification of the PG is challenging in thyroid surgery as it is similar in color...
Parathyroid gland (PG) identification is a critical unmet need in thyroidectomy. The identification of the PG is challenging in thyroid surgery as it is similar in color to the thyroid gland. The lack of effective animal models in preclinical research is a severe limitation for the development of PG identification techniques. This protocol allows for the establishment of a simple and effective rat model for PG identification. In this model, black iron oxide nanoparticles (IONPs) are injected locally in the thyroid gland and rapidly diffuse within the thyroid gland but not the PG. A negatively stained PG and a positively stained thyroid gland can be easily identified by the naked eye without requiring external microscopes. The position of the PG can be identified by increasing the color contrast between the thyroid gland and the PG, based on the color of the black IONPs. This rat model is low-cost and convenient for PG identification, and the IONPs are a novel PG contrast agent.
Topics: Animals; Nanoparticles; Neck; Parathyroid Glands; Rats; Thyroid Gland; Thyroidectomy
PubMed: 36063017
DOI: 10.3791/64222 -
Diagnostic and Interventional Imaging May 2022The purpose of this study was to assess the diagnostic capabilities of preoperative conventional imaging (Tc-MIBI scintigraphy, cervical ultrasonography [CUS]) and...
PURPOSE
The purpose of this study was to assess the diagnostic capabilities of preoperative conventional imaging (Tc-MIBI scintigraphy, cervical ultrasonography [CUS]) and F-fluorocholine PET/CT (FCH PET/CT) in the detection of hyperfunctioning parathyroid gland in patients with primary hyperparathyroidism (PHPT) used alone or as a single imaging set.
MATERIALS AND METHODS
A total of 51 consecutive patients (6 men, 45 women; mean age, 62 ± 11.6 [SD] years; age range: 28-86 years) with biochemically confirmed PHPT who underwent CUS, single-tracer dual phase Tc-MIBI scintigraphy and FCH PET/CT were retrospectively included. Tc-MIBI scintigraphy were performed immediately after CUS and interpreted by the same operators. FCH PET/CT examinations were interpreted independently by two nuclear medicine physicians. An additional reading session integrating the three imaging modalities read in consensus as a combined imaging set was performed.
RESULTS
At surgery, 74 lesions were removed (32 parathyroid adenomas, 38 parathyroid hyperplasia and 4 subnormal glands). Thirty-six patients (71%) had single-gland disease and 15 patients (29%) had multiglandular disease at histopathological analysis. On a patient basis, sensitivity and accuracy of FCH PET/CT, CUS and Tc-MIBI scintigraphy for the detection of abnormal parathyroid glands were 76% (95% CI: 63-87%) and 76% (95% CI: 63-87%), 71% (95% CI: 56-83%) and 71% (95% CI: 56-83%), 33% (95% CI: 21-48%) and 33% (95% CI: 21-48%), respectively. The sensitivity of the combined imaging set was 94% (95% CI: 84-99%) and greater than the sensitivity of each individual imaging technique (P ≤ 0.001 for all).
CONCLUSION
Our results suggest that CUS, Tc-MIBI scintigraphy and FCH PET/CT interpreted as a single imaging set could be the ideal practice to precisely localize parathyroid lesion in patients with PHPT before surgery.
Topics: Adult; Aged; Aged, 80 and over; Choline; Female; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroid Glands; Positron Emission Tomography Computed Tomography; Retrospective Studies; Technetium Tc 99m Sestamibi
PubMed: 35039246
DOI: 10.1016/j.diii.2021.12.005 -
Seminars in Dialysis Sep 2016In secondary hyperparathyroidism (SHPT), ultrasonography (US) can accurately define the size and structure of parathyroid glands as well as differentiate diffuse and...
In secondary hyperparathyroidism (SHPT), ultrasonography (US) can accurately define the size and structure of parathyroid glands as well as differentiate diffuse and nodular hyperplasia. US may be also useful to predict the response of SHPT to vitamin D analogs and cinacalcet and to assess for regression of parathyroid glands hyperplasia by measurement of parathyroid gland volume. There is increasing evidence that US can potentially identify patients who will benefit from prompt surgical intervention. Therefore, US should be part of the diagnostic armamentarium in the treatment of SHPT in the daily clinical practice.
Topics: Cinacalcet; Humans; Hyperparathyroidism, Secondary; Parathyroid Glands; Ultrasonography
PubMed: 27419923
DOI: 10.1111/sdi.12521 -
PloS One 2020Parathyroid gland disorders are rare conditions with an incidence that displays great variability among populations. Its direct influence in calcium homeostasis...
Parathyroid gland disorders are rare conditions with an incidence that displays great variability among populations. Its direct influence in calcium homeostasis originates variable symptoms that affect bone remodelling among other processes. This study aimed to provide data on the epidemiology and characteristics of patients admitted with these disorders in Spain between 2003 and 2017, and to analyse disease management and direct medical costs. Medical records in which a disorder of the parathyroid gland was registered as the admission motive were extracted from a nationwide hospital-discharge database via the Spanish Ministry of Health. Records from 12,903 patients were obtained, with predominance of female patients (74.70%) and of admissions due to hyperparathyroidism (90.23%). The number of patients admitted per year increased over the study period along the incidence of these disorders. The year 2017 incidence of hyperparathyroidism was 2.95 per 10,000, 4.03 per 10,000 in females and 1.37 in males; the same year, the incidence of hypoparathyroidism was 0.17 per 10,000. Length of hospital stay was significantly extended in patients with hypoparathyroidism (7.16 days), admitted mostly due to emergencies. Heart failure was diagnosed in more than 20% of admissions in patients with secondary and tertiary hyperparathyroidism and hypoparathyroidism, while this last group displayed the highest levels of mineral metabolism disruption. Parathyroidectomy was performed in 78.95% of all admissions for primary hyperparathyroidism. The total annual direct medical cost parathyroid gland disorders has increased over the study period, due to the increase of the costs associated to hyperparathyroidism, whereas the cost per patient remained relatively stable, with an average of €3,748, €3,430 and €3,737 for patients with hyperparathyroidism, hypoparathyroidism and other disorders of the parathyroid gland, respectively. This study provides novel data to extend the scarce available knowledge on parathyroid gland disorders' epidemiology and management in Spain.
Topics: Adult; Female; Humans; Hyperparathyroidism, Primary; Hypoparathyroidism; Incidence; Male; Middle Aged; Parathyroid Diseases; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Retrospective Studies; Spain
PubMed: 32155210
DOI: 10.1371/journal.pone.0230130 -
Therapeutic Apheresis and Dialysis :... Feb 2018The goal of the pharmacological therapy in secondary hyperparathyroidism (SHPT) is to reduce serum levels of parathyroid hormone and phosphorus, to correct those of... (Review)
Review
The goal of the pharmacological therapy in secondary hyperparathyroidism (SHPT) is to reduce serum levels of parathyroid hormone and phosphorus, to correct those of calcium and vitamin D, to arrest or reverse the parathyroid hyperplasia. However, when nodular hyperplasia or an autonomous adenoma develops, surgery may be indicated. We reviewed the literature with the aim of defining if the echographic criteria predictive of unresponsiveness of SHPT to calcitriol therapy are valid also in the cinacalcet era and if drug therapy may reverse nodular hyperplasia of parathyroid gland (PTG). The responsiveness to therapy and regression of the nodular hyperplasia of PTG remains an open question in the calcimimetic era as well as the cutoff between medical and surgical therapy. Prospective studies are needed in order to clarify if an earlier use of cinacalcet in moderate SHPT might arrest the progression of parathyroid growth and stabilize SHPT.
Topics: Calcimimetic Agents; Calcitriol; Calcium Channel Agonists; Cinacalcet; Humans; Hyperparathyroidism, Secondary; Hyperplasia; Parathyroid Glands; Treatment Outcome
PubMed: 28980761
DOI: 10.1111/1744-9987.12604 -
Surgery Feb 2019Although parathyroid glands have been found to exhibit autofluorescence with near-infrared fluorescence imaging, it is unknown if autofluorescence characteristics vary...
BACKGROUND
Although parathyroid glands have been found to exhibit autofluorescence with near-infrared fluorescence imaging, it is unknown if autofluorescence characteristics vary between hyperfunctioning and normofunctioning glands. The hypothesis was that pattern of autofluorescence exhibited by hyperfunctioning versus normofunctioning parathyroid glands would be different.
METHODS
This is an Institutional Review Board-approved, prospective clinical study. Patients underwent bilateral neck exploration for primary hyperparathyroidism, during which autofluorescence from each gland was assessed with near-infrared fluorescence imaging. Pattern and intensity of autofluorescence between hyperfunctioning and normofunctioning parathyroid glands were compared.
RESULTS
Overall, 199 parathyroid glands were identified in 50 patients (single gland disease, n = 31; multigland disease, n = 19). Autofluorescence was detected from 96% (n = 192) of parathyroid glands, all of which exhibited a higher intensity autofluorescence than the background tissues. Parathyroid gland location was revealed by near-infrared fluorescence imaging before dissection in 26% (n = 52). A total of 77 glands that were large or firm were excised and 122 were preserved because of normal appearance. Hyperfunctioning parathyroid glands had a lower mean normalized autofluorescence intensity than normofunctioning parathyroid glands (1.8, and 2.6, respectively, P < .001). Moreover, hyperfunctioning parathyroid glands more often exhibited a heterogeneous pattern of autofluorescence (75% and 5%, respectively, P < .001). On multivariate analysis, only parathyroid gland hyperfunction correlated with normalized autofluorescence intensity. On receiver operative characteristic curve, optimal cutoff of normalized autofluorescence intensity to differentiate hyperfunctioning from normofunctioning parathyroid glands was 2.0.
CONCLUSION
Our results indicate that hyperfunctioning and normofunctioning parathyroid glands exhibit different patterns of autofluorescence in hyperparathyroidism. Given these findings, autofluorescence pattern could be implemented as another adjunctive parameter for gland assessment during parathyroid exploration.
Topics: Adenoma; Female; Fluorescence; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy; Prospective Studies; Sensitivity and Specificity; Software; Spectroscopy, Near-Infrared
PubMed: 30274733
DOI: 10.1016/j.surg.2018.08.006 -
Endocrine Sep 2023Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection affects several important organs including endocrine glands. Experimental studies demonstrated... (Review)
Review
Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection affects several important organs including endocrine glands. Experimental studies demonstrated that the virus exploits the ACE2, a transmembrane glycoprotein on the cell surface as a receptor for cellular entry. This entry process is exclusively facilitated by other intracellular protein molecules such as TMPRSS2, furin, NRP1, and NRP2. Recent findings documented the involvement of the SARS-CoV-2 in inducing various parathyroid disorders including hypoparathyroidism and hypocalcemia, which received significant attention. This review extensively describes rapidly evolving knowledge on the potential part of SARS-CoV-2 in emerging various parathyroid disorders due to SARS-CoV-2 infection particularly parathyroid malfunction in COVID-19 cases, and post-COVID-19 conditions. Further, it presents the expression level of various molecules such as ACE2, TMPRSS2, furin, NRP1, and NRP2 in the parathyroid cells that facilitate the SARS-CoV-2 entry into the cell, and discusses the possible mechanism of parathyroid gland infection. Besides, it explores parathyroid malfunction in COVID-19 vaccine-administered cases. It also explains the possible long-COVID-19 effect on parathyroid and post-COVID-19 management of parathyroid. A complete understanding of the mechanisms of SARS-CoV-2-triggered pathogenesis in parathyroid dysfunctions may curtail treatment options and aid in the management of SARS-CoV-2-infected cases.
Topics: Humans; SARS-CoV-2; COVID-19; Furin; COVID-19 Vaccines; Parathyroid Glands; Angiotensin-Converting Enzyme 2; Post-Acute COVID-19 Syndrome; Peptidyl-Dipeptidase A
PubMed: 37328666
DOI: 10.1007/s12020-023-03415-6 -
Terapevticheskii Arkhiv Apr 2018The article presents data on modern approaches to the diagnosis of various manifestations of hyperparathyroidism according to multispiral computed tomography, which do... (Review)
Review
The article presents data on modern approaches to the diagnosis of various manifestations of hyperparathyroidism according to multispiral computed tomography, which do not require morphological verification and ensure the correctness of the diagnostic process. The radiological picture and differential diagnostics of changes from parathyroid glands and bone structures at hyperparathyroidism are described in detail.
Topics: Humans; Hyperparathyroidism, Primary; Parathyroid Glands; Tomography, X-Ray Computed
PubMed: 30701876
DOI: 10.26442/terarkh201890460-66 -
Otolaryngology--head and Neck Surgery :... Mar 2022Enhanced recovery after surgery (ERAS) protocols are evidenced-based multidisciplinary programs implemented in the perioperative setting to improve postoperative... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Enhanced recovery after surgery (ERAS) protocols are evidenced-based multidisciplinary programs implemented in the perioperative setting to improve postoperative recovery and attenuate the surgical stress response. However, evidence on their effectiveness in thyroid and parathyroid surgery remains sparse. Therefore, our goal was to investigate the clinical benefits and cost-effectiveness of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy.
DATA SOURCE
A systematic review of Medline, Scopus, Embase, and gray literature was performed to identify studies of ERAS or clinical care protocols for thyroidectomy and parathyroidectomy.
REVIEW METHODS
Two reviewers screened studies using predetermined inclusion criteria. Our primary outcomes included hospital length of stay and hospital costs. Readmission and postoperative complication rates composed our secondary outcomes. Meta-analysis was performed to compare outcomes for patients enrolled in the ERAS protocol versus standard of care.
RESULTS
A total of 450 articles were identified; 7 (1.6%) met inclusion criteria with a total of 3082 patients. Perioperative components in ERAS protocols varied across the studies. Nevertheless, patients enrolled in ERAS protocols had reduced hospital length of stay (mean difference, -0.64 days [95% CI, -0.92 to -0.37]) and hospital costs (in US dollars; mean difference, -307.70 [95% CI, -346.49 to -268.90]), without an increase in readmission (odds ratio, 0.75 [95% CI, 0.29-1.94]) or complication rates (odds ratio, 1.14 [95% CI, 0.82-1.57]).
CONCLUSION
There is growing literature supporting the role of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. These protocols significantly reduce hospital length of stay and costs without increasing complications or readmission rates.
Topics: Endocrine Surgical Procedures; Enhanced Recovery After Surgery; Hospital Costs; Humans; Length of Stay; Parathyroid Glands; Postoperative Complications; Thyroid Gland
PubMed: 34126805
DOI: 10.1177/01945998211019671 -
Khirurgiia 2022To offer the ways for safe thyroidectomy aimed at prevention of damage of recurrent laryngeal nerve in patients with thyroid and parathyroid diseases.
OBJECTIVE
To offer the ways for safe thyroidectomy aimed at prevention of damage of recurrent laryngeal nerve in patients with thyroid and parathyroid diseases.
MATERIAL AND METHODS
We analyzed postoperative outcomes after thyroidectomy in 342 patients aged 20-80 years. Topography of recurrent laryngeal nerves was studied on 20 laryngeal-tracheal complexes of deceased patients. Technique of visualization of various segments of recurrent laryngeal nerve was worked out.
RESULTS AND DISCUSSION
Thyroidectomy was performed in 342 patients with thyroid and parathyroid diseases. Thyroidectomy was performed in accordance with recommendations described by F.W. Lahey, W.B. Hoover (1938) and H. Malcolm, M.D. Wheeler (1998). Location of recurrent laryngeal nerve varied in patients with nodular, retrosternal goiter and parathyroid gland adenoma. Comparison of intraoperative and morphological data on recurrent laryngeal nerve visualization showed possible risks of its damage during manipulations on thyroid gland, esophagus and trachea. Our study confirmed the need for visualization and mobilization of recurrent laryngeal nerve in all procedures on thyroid and parathyroid glands. Introduction of the described technique of thyroidectomy and training sessions for recurrent laryngeal nerve mobilization on laryngeal-tracheal complexes reduced postoperative incidence of phonation disorders from 21.6% to 0.98%.
CONCLUSION
Thyroidectomy may be a safe procedure if surgeons are familiar with the details of surgical technique and prevent damage to adjacent structures.
Topics: Goiter, Nodular; Humans; Parathyroid Diseases; Parathyroid Glands; Parathyroidectomy; Thyroid Diseases; Thyroidectomy; Vocal Cord Paralysis
PubMed: 35658138
DOI: 10.17116/hirurgia202206162