-
BMC Surgery Sep 2023The published rate of incidental parathyroidectomy (IP) during thyroid surgery varies between 5.8% and 29%. The risk factors and clinical significance of postoperative...
BACKGROUND
The published rate of incidental parathyroidectomy (IP) during thyroid surgery varies between 5.8% and 29%. The risk factors and clinical significance of postoperative transient hypocalcemia and permanent hypoparathyroidism are still debated. The aims of this study were to assess the clinical relevance of avoidable IP for transient hypocalcemia and permanent hypoparathyroidism, and to describe the risk factors for IP.
METHODS
This retrospective cohort study included 1,537 patients who had a one-step total thyroidectomy in a high-volume endocrine surgery center between 2018 and 2019. Pathology reports were reviewed for incidentally removed parathyroid glands. Intrathyroidal parathyroid glands were excluded from the study. Demographic characteristics, potential risk factors, and postoperative calcium and PTH levels were compared between IP and control groups.
RESULTS
Avoidable IP occurred in 234 (15.2%) patients. Patients with IP had a higher risk of transient hypocalcemia (17.9% vs. 11.5%, p = 0.006; odds ratio [OR] 1.68, 95% confidence interval [95% CI]1.16-2.45) and permanent hypoparathyroidism (4.7% vs. 1.6%, p = 0.002; OR 3.01, 95% CI 1.29-6.63) than patients without IP. Multivariate analysis showed that central lymph node dissection (CLND) and incidental removal of thymus tissue were independent risk factors for IP (OR 4.83, 95% CI 2.71-8.86, p < 0.001 and OR 1.72, 95% CI 1.02-2.82, p = 0.038).
CONCLUSIONS
Patients with IP were more likely to develop transient hypocalcemia and permanent hypoparathyroidism, indicating the clinical significance of avoidable IP for patients and the need for raising awareness among surgeons. Patients undergoing CLND are at a higher risk for IP, and should be adequately informed and treated. Any removal of thymus tissue should be avoided during CLND.
Topics: Humans; Parathyroid Glands; Parathyroidectomy; Thyroidectomy; Hypocalcemia; Retrospective Studies; Hypoparathyroidism
PubMed: 37674156
DOI: 10.1186/s12893-023-02176-3 -
Revista Da Associacao Medica Brasileira... Feb 2021The parathormone level after parathyroidectomy in dialysis patients are of interest. Low levels may require cryopreserved tissue implantation; however, the resection is...
OBJECTIVE
The parathormone level after parathyroidectomy in dialysis patients are of interest. Low levels may require cryopreserved tissue implantation; however, the resection is necessary in case of recurrence. We analyzed post parathyroidectomy parathormone levels in renal hyperparathyroidism.
METHODS
Prospective observation of postoperative parathormone levels over defined periods in a cohort of dialysis patients that underwent total parathyroidectomy and immediate forearm autograft from 2008 to 2010, at a single tertiary care hospital.
RESULTS
Of 33 patients, parathormone levels until 36 months could be divided into four patterns. Patients with stable function (Pattern 1) show relatively constant levels after two months (67% of the cases). Early function and later failure (Pattern 2) were an initial function with marked parathormone reduction before one year (18%). Graft recurrence (Pattern 3) showed a progressive increase of parathormone in four cases (12%). Complete graft failure (Pattern 4) was a nonfunctioning implant at any period, which was observed in one patient (3%). Parathormone levels of Pattern 3 became statistically different of Pattern 1 at 36 months.
CONCLUSIONS
Patients that underwent the total parathyroidectomy and autograft present four different graft function patterns with a possible varied therapeutic management.
Topics: Humans; Hyperparathyroidism, Secondary; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Prospective Studies; Recurrence; Transplantation, Autologous
PubMed: 34231767
DOI: 10.1590/1806-9282.67.02.20200609 -
The Journal of Surgical Research May 2015Tertiary hyperparathyroidism (3HPT) is defined as the persistent hyperproduction of parathyroid hormone and resulting hypercalcemia after renal transplantation. Here, we...
BACKGROUND
Tertiary hyperparathyroidism (3HPT) is defined as the persistent hyperproduction of parathyroid hormone and resulting hypercalcemia after renal transplantation. Here, we examine the utility of radioguided parathyroidectomy (RGP) in patients with 3HPT.
MATERIALS AND METHODS
We reviewed a prospective surgery database containing 80 3HPT patients who underwent RGP from January 2001-July 2014 at our institution. We evaluated patient demographics, operative management, radioguided neoprobe utilization, and operative outcomes. Data are reported as mean ± standard error of the mean.
RESULTS
The mean age of the patients was 52 ± 1 y, and 46% were male. A total of 69 patients had hyperplasia and received subtotal parathyroidectomy, whereas 5 patients had double adenomas and 6 patients had single adenomas. The average calcium level among 3HPT patients was 10.8 ± 0.1 mg/dL preoperatively and 8.7 ± 0.1 mg/dL postoperatively. In vivo radioguided counts normalized to background counts averaged 145 ± 4%, whereas ex vivo counts normalized to background counts averaged 69 ± 5%. All but one ex vivo count was >20%. Ectopically located glands were successfully localized in 38 patients using the gamma probe. Ex vivo percentage did not correlate with parathyroid gland weight, preoperative parathyroid hormone, or preoperative calcium. Our radioguided approach achieved normocalcemia in 96% of 3HPT patients undergoing RGP; two patients developed recurrent disease.
CONCLUSIONS
In this series, all enlarged parathyroid glands were localized and resected using the gamma probe. Thus, RGP reliably localizes adenomatous, hyperplastic, and ectopically located glands in patients with 3HPT, resulting in high cure rate after resection.
Topics: Female; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Hormone; Parathyroidectomy; Radiopharmaceuticals; Technetium Tc 99m Sestamibi
PubMed: 25770735
DOI: 10.1016/j.jss.2015.02.015 -
Problemy Endokrinologii Jan 2022For a comprehensive assessment of the effect of surgery in patients with primary hyperparathyroidism (PHPT), as well as for monitoring the condition of patients after... (Observational Study)
Observational Study
BACKGROUND
For a comprehensive assessment of the effect of surgery in patients with primary hyperparathyroidism (PHPT), as well as for monitoring the condition of patients after treatment, it sounds reasonable to evaluate quality of life (QoL) and symptoms in PHPT patients before and after surgery.
AIM
The aim of this study was to assess changes in the QoL and symptoms in patients with PHPT after surgery.
MATERIALS AND METHODS
During prospective observational study, patients filled out QoL questionnaires and evaluated the presence and severity of their symptoms prior to parathyroidectomy (PTE) and 3, 12 months after surgery. Statistical analysis included the following methods: Student's t-test or Wilcoxon's non-parametric test, the generalized estimating equations (GEE), correlation analysis, χ2 and McNemar tests.
RESULTS
The study included 72 patients (mean age 52 years, 97.2% female) with symptomatic (68.1%) and asymptomatic (31.9%) PHPT. Before surgery patients with PHPT exhibited significantly decreased role functioning, physical and social well-being, and vitality. Half of PHPT patients experienced moderate-to-severe symptoms such as weakness, fatigue, loss of concentration, mood changes, as well as joint and bone pain; the association between symptoms experienced and the extent of QoL impairment before surgery was shown. Three months after PTE improvement in both physical and psychological components of QoL was shown. Positive QoL changes were demonstrated in patients with both symptomatic and asymptomatic PHPT and they preserved for 12 months after surgery. Also within 12 months after PTE significant decrease in PHPT-associated symptoms such as weakness, fatigue, loss of concentration and mood changes was found.
CONCLUSION
The results obtained demonstrate efficacy of PTE from the patient's perspective and confirm the value of QoL assessment in PHPT patients in management of this patients' population both for decision making and for evaluation of benefits of surgery and the degree of recovery of patients at long term follow-up.
Topics: Female; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroidectomy; Prospective Studies; Quality of Life; Surveys and Questionnaires
PubMed: 35262295
DOI: 10.14341/probl12825 -
American Journal of Surgery Jul 2022Management of asymptomatic primary hyperparathyroidism (PHPT) in older patients (age >50) is controversial. The 4th International Workshop on the Management of...
BACKGROUND
Management of asymptomatic primary hyperparathyroidism (PHPT) in older patients (age >50) is controversial. The 4th International Workshop on the Management of Asymptomatic PHPT recommends surveillance for older patients who lack objective signs of disease, whereas The American Association of Endocrine Surgeons (AAES) guidelines recommend consideration of parathyroidectomy for patients of any age with subjective constitutional, neuropsychiatric, or cognitive symptoms. Therefore, the primary objective of this study was to evaluate the association between patient age and both practice patterns and outcomes in the management of patients with sporadic PHPT.
METHODS
The Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) database was queried for all adults (age ≥18) who underwent an index parathyroidectomy for sporadic primary hyperparathyroidism between 2014 and 2020. Associations between patient age (≤50 years vs. >50 years) and both practice patterns and outcomes were evaluated separately using adjusted multivariable logistic and multinomial regression models.
RESULTS
Of 9,938 patients who underwent parathyroidectomy, 8,080 (81.3%) were >50 years old and 1,858 (18.7%) were ≤50. Of this cohort, 17% of older patients and 26% of younger patients presented with only subjective symptoms. Compared to younger patients, older patients were more likely to have an objective indication for parathyroidectomy (aOR = 1.8, 95%CI: 1.6-2.0, p < 0.001). They were also more likely to undergo ≥2 imaging studies pre-operatively (aOR = 1.2, 95%CI: 1.1-1.3, p = 0.003), to undergo bilateral neck exploration (aOR = 1.4, 95%CI: 1.3-1.6, p < 0.001), and to have multi-gland disease (aOR = 1.6, 95%CI: 1.4-1.8, p < 0.001). There was no difference between age groups and parathyroidectomy-related complications including hypocalcemia, vocal cord dysfunction, hematoma requiring evacuation, or reintubation, however, older patients were less likely to have any peri-operative morbidity (aOR = 0.7, 95%CI: 0.6-0.9, p = 0.011).
CONCLUSIONS
Older patients were more likely to meet objective criteria prior to undergoing parathyroidectomy by CESQIP participating high-volume endocrine surgeons, however they were less likely to have peri-operative complications compared to younger patients. Given the growing evidence demonstrating improvement of both objective and subjective symptoms after parathyroidectomy for PHPT, additional studies are still needed to fully understand the benefit of surgical referral in older adults for less objective indications.
Topics: Aged; Cohort Studies; Humans; Hyperparathyroidism, Primary; Hypocalcemia; Middle Aged; Parathyroidectomy; Retrospective Studies
PubMed: 35339271
DOI: 10.1016/j.amjsurg.2022.03.007 -
Annals of African Medicine 2020
Topics: Adult; Calcium; Dietary Supplements; Humans; Hyperparathyroidism, Primary; Hypocalcemia; Incidental Findings; Male; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy; Postoperative Period; Treatment Outcome
PubMed: 32174619
DOI: 10.4103/aam.aam_11_19 -
Langenbeck's Archives of Surgery Dec 2023Focused parathyroidectomy is the gold standard treatment modality for primary hyperparathyroidism, which allows accurate preoperative localization. Robotic...
PURPOSE
Focused parathyroidectomy is the gold standard treatment modality for primary hyperparathyroidism, which allows accurate preoperative localization. Robotic parathyroidectomy has emerged as a feasible procedure for focused parathyroidectomy. This study aimed to report the experiences of gasless robotic transaxillary parathyroidectomy for primary hyperparathyroidism in a single center.
METHODS
We assessed the data obtained from patients who underwent gasless robotic parathyroidectomy with the transaxillary approach between December 2013 and August 2022 and were diagnosed with primary hyperparathyroidism at our institute. The data included clinical, biochemical, and pathological features and operation time.
RESULTS
Of the 12 patients, 11 were women and one was a man. The median age of the patients was 44.5 years (range: 15-65 years). The median preoperative maximum mass diameters on ultrasonography and neck computed tomography were 1.2 ± 0.5 and 1.1 ± 0.6 cm, respectively. The median size of the postoperative maximum mass diameter in gross pathology was 1.3 ± 0.4 cm. The location of the enlarged parathyroid was left superior in five patients, right inferior in four, left inferior in three, and no right superior in one. In the final pathological examination, all cases were parathyroid adenomas. Only one case experienced a postoperative bleeding complication. At six months from surgery, average of an axillary scar length was 5.85 cm, and an average width was 0.21 cm. The mean operative time was 113 ± 48 min. The mean robot docking and console times were 9 ± 5 and 47 ± 52 min, respectively.
CONCLUSIONS
Robotic transaxillary parathyroidectomy is a feasible technique in select patients with primary hyperparathyroidism and preoperatively localized disease. The gasless robotic transaxillary approach provides procedural safety as well as superior cosmetic results without a neck scar.
Topics: Male; Humans; Female; Adolescent; Young Adult; Adult; Middle Aged; Aged; Robotics; Parathyroidectomy; Robotic Surgical Procedures; Hyperparathyroidism, Primary; Cicatrix; Postoperative Complications
PubMed: 38103090
DOI: 10.1007/s00423-023-03182-y -
International Journal of Hyperthermia :... 2022To investigate the efficacy of radiofrequency ablation (RFA) as a treatment option for primary hyperparathyroidism (pHPT) and risk factors for postablative eucalcemic...
OBJECTIVE
To investigate the efficacy of radiofrequency ablation (RFA) as a treatment option for primary hyperparathyroidism (pHPT) and risk factors for postablative eucalcemic parathyroid hormone elevation (ePTH).
METHODS
This retrospective study included 51 patients with pHPT who underwent RFA. The patients were divided into the ePTH and normal PTH groups, based on the serum intact parathyroid hormone (iPTH) level one month after ablation. Serum iPTH, calcium, and phosphorus levels, and the volume reduction rates (VRR) of the parathyroid glands were compared between the groups at each follow-up point. Risk factors for ePTH at one month after ablation were examined.
RESULTS
After RFA, one (2%) patient had persistent pHPT, and 50 (98%) patients were cured. The incidence rates of ePTH at 1, 3, 6, and 12 months were 48%, 30%, 20%, and 16%, respectively. Serum iPTH levels in the ePTH group were higher than those in the normal PTH group at each follow-up point (all < 0.05), except 1 day after ablation ( > 0.05). Serum calcium and phosphorus levels, and the VRR of the glands were comparable in both groups at each follow-up point (all > 0.05), except for calcium levels 3 days after RFA ( < 0.05). Baseline iPTH (odds ratio, 1.067; = 0.045) and calcium (odds ratio, 3.923; = 0.038) levels were independent risk factors for ePTH 1 month after RFA.
CONCLUSIONS
RFA is safe and effective for the treatment of pHPT. Moreover, ePTH occurrence after RFA was associated with baseline iPTH and calcium levels and did not increase the risk of recurrent pHPT.
Topics: Calcium; Humans; Hyperparathyroidism, Primary; Parathyroid Hormone; Parathyroidectomy; Radiofrequency Ablation; Retrospective Studies; Risk Factors
PubMed: 35285391
DOI: 10.1080/02656736.2022.2047231 -
Frontiers in Endocrinology 2023
Topics: Parathyroid Hormone; Calcium; Parathyroidectomy; Calcium, Dietary
PubMed: 37188053
DOI: 10.3389/fendo.2023.1199056 -
European Annals of Otorhinolaryngology,... Apr 2017The aim of the study was to stimulate the vagal and the recurrent laryngeal nerves during and after thyroidectomy or parathyroidectomy, to record muscle responses,...
OBJECTIVES
The aim of the study was to stimulate the vagal and the recurrent laryngeal nerves during and after thyroidectomy or parathyroidectomy, to record muscle responses, interpret the electrophysiological modifications and identify prognostic factors for postoperative vocal fold mobility.
PATIENTS AND METHODS
A prospective study monitored 151 vagal nerves and 144 recurrent laryngeal nerves in 114 patients. Seven patients (14 vagal nerves) underwent continuous monitoring via an automatic periodic stimulation (APS) electrode. In 15 patients (21 vagal nerves), the stimulation threshold was studied. Muscle response was recorded on direct vagal and/or recurrent laryngeal nerve stimulation by a monopolar electrode or direct repeated stimulation via an electrode on the vagal nerve. In case of signal attenuation on the first operated side, surgery was not extended to the contralateral side.
RESULTS
The vagal nerve stimulation checked inferior laryngeal nerve integrity and recurrent status, without risk of false negatives. The vagal nerve stimulation threshold, before and after dissection, that induced a muscle response of at least 100μV ranged from 0.1 to 0.8mA. Similarity between pre- and post-dissection responses to supramaximal stimulation, defined as 1mA, on the one hand, and between post-dissection vagal and laryngeal recurrent nerve responses on the other correlated with normal postoperative vocal cord mobility. Conversely, muscle response attenuation below 100μV and increased latency indicated a risk of vocal fold palsy.
CONCLUSION
Vagal nerve stimulation allows suspicion or elimination of lesions on the inferior laryngeal nerve upstream of the stimulation point and detection of non-recurrent inferior laryngeal nerve. Intermittent monitoring assesses nerve function at the moment of stimulation, while continuous monitoring detects the first signs of nerve injury liable to induce postoperative recurrent nerve palsy. When total thyroidectomy is indicated, signal attenuation on the first operated side casts doubt on continuing surgery to the contralateral side in the same step.
Topics: Adult; Aged; Aged, 80 and over; Dissection; Female; Humans; Male; Middle Aged; Monitoring, Intraoperative; Parathyroid Diseases; Parathyroidectomy; Prospective Studies; Recurrent Laryngeal Nerve Injuries; Thyroid Diseases; Thyroidectomy; Treatment Outcome; Vagus Nerve Stimulation; Vocal Cord Paralysis
PubMed: 28034706
DOI: 10.1016/j.anorl.2016.11.003