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Expert Review of Endocrinology &... Nov 2020The parathyroid glands (PGs) are critical for calcium regulation and homeostasis. The preservation of PGs during neck surgery is crucial to avoid postoperative... (Review)
Review
INTRODUCTION
The parathyroid glands (PGs) are critical for calcium regulation and homeostasis. The preservation of PGs during neck surgery is crucial to avoid postoperative hypoparathyroidism. There are no existing guidelines for intraoperative PG identification, and the current approach relies heavily on the experience of the operating surgeon. A technique that accurately and rapidly identifies PGs would represent a useful intraoperative adjunct.
AREAS COVERED
This review aims to assess common dye and fluorescence-based PG imaging techniques and examine their utility for intraoperative PG identification. A literature search of published data on methylene blue (MB), indocyanine green (ICG) angiography, near-infrared autofluorescence (NIRAF), and the PGs between 1971 and 2020 was conducted on PubMed.
EXPERT OPINION
NIRAF and near-infrared (NIR) parathyroid angiography have emerged as promising and reliable techniques for intraoperative PG identification. NIRAF may aid with real-time identification of both normal and diseased PGs and reduce the risk of postoperative complications such as hypocalcemia. Further large prospective multicenter studies should be conducted in thyroid and parathyroid surgical patient populations to confirm the clinical efficacy of these intraoperative NIR-based PG detection techniques.
Topics: Angiography; Fluorescence; Humans; Hypocalcemia; Hypoparathyroidism; Intraoperative Period; Optical Imaging; Parathyroid Glands; Parathyroidectomy; Postoperative Complications; Surgical Wound; Thyroidectomy; Transplantation, Autologous
PubMed: 33074033
DOI: 10.1080/17446651.2020.1831913 -
Physiological Research Dec 2023Multiglandular primary hyperparathyroidism (MGD) represents a rare form of primary hyperparathyroidism (PHPT). MGD is associated with hereditary PHPT, but the sporadic... (Review)
Review
Multiglandular primary hyperparathyroidism (MGD) represents a rare form of primary hyperparathyroidism (PHPT). MGD is associated with hereditary PHPT, but the sporadic MGD is more common and affects a similar patient profile as single gland parathyroid disease (SGD). The distinction between SGD and MGD is of great clinical importance, especially for the strategy of parathyroidectomy. Based on the limited knowledge available, MGD is likely to be a genetically heterogeneous disease resulting from the interaction of germline and somatic DNA mutations together with epigenetic alterations. Furthermore, these events may combine and occur independently in parathyroid tumors within the same individual with MGD. Gene expression profiling has shown that SGD and MGD may represent distinct entities in parathyroid tumorigenesis. We are waiting for studies to analyze exactly which genes are different in SGD and MGD in order to identify potential biomarkers that can distinguish between the two forms of the disease.
Topics: Humans; Hyperparathyroidism, Primary; Parathyroid Hormone; Retrospective Studies; Parathyroid Glands; Molecular Biology
PubMed: 38116772
DOI: 10.33549/physiolres.935253 -
Current Medical Imaging 2021Embryologic developmental variants of the thyroid and parathyroid glands may cause cervical anomalies that are detectable in ultrasound examinations of the neck. For...
Embryologic developmental variants of the thyroid and parathyroid glands may cause cervical anomalies that are detectable in ultrasound examinations of the neck. For some of these developmental variants, molecular genetic factors have been identified. Ultrasound, as the first-line imaging procedure, has proven useful in detecting clinically relevant anatomic variants. The aim of this article was to systematically summarize the ultrasound characteristics of developmental variants of the thyroid and parathyroid glands as well as ectopic thymus and neck cysts. Quantitative measures were developed based on our findings and the respective literature. Developmental anomalies frequently manifest as cysts that can be detected by cervical ultrasound examinations. Median neck cysts are the most common congenital cervical cystic lesions, with a reported prevalence of 7% in the general population. Besides cystic malformations, developmental anomalies may appear as ectopic or dystopic tissue. Ectopic thyroid tissue is observed in the midline of the neck in most patients and has a prevalence of 1/100,000 to 1/300,000. Lingual thyroid accounts for 90% of cases of ectopic thyroid tissue. Zuckerkandl tubercles (ZTs) have been detected in 55% of all thyroid lobes. Prominent ZTs are frequently observed in thyroid lobes affected by autoimmune thyroiditis compared with normal lobes or nodular lobes (P = 0.006). The correct interpretation of the ultrasound characteristics of these variants is essential to establish the clinical diagnosis. In the preoperative assessment, the identification of these cervical anomalies via ultrasound examination is indispensable.
Topics: Humans; Neck; Parathyroid Glands; Thyroid Diseases; Ultrasonography
PubMed: 33504311
DOI: 10.2174/1573405617666210127162328 -
European Archives of... Aug 2020To report the outcomes of parathyroid gland (PG) identification and autotransplantation (autoT) during thyroidectomy.
PURPOSE
To report the outcomes of parathyroid gland (PG) identification and autotransplantation (autoT) during thyroidectomy.
METHODS
Consecutive total thyroidectomy cases performed by a single surgeon using extracapsular dissection technique were considered. PGs were not intentionally sought during dissection. PG location, number identified and autoT were prospectively recorded and correlated to postoperative outcomes.
RESULTS
In all, 265 cases were included. The mean number of PGs identified per case was 2.7. The number of PGs identified had no correlation to postoperative hypocalcemia. However, independent risk factors for hypocalcemia were female sex, bilateral central compartment neck dissection (CND) and autoT > 1 PG; and for permanent hypoparathyroidism were female sex and bilateral CND. AutoT did not protect against permanent hypoparathyroidism.
CONCLUSION
The number of PGs identified during the course of a standard extracapsular dissection technique had no correlation to postoperative hypocalcemia. Whenever possible, avoiding bilateral CND and careful techniques to preserve PGs in an in situ and viable state, to obviate the necessity for autoT, are recommended.
Topics: Female; Humans; Hypocalcemia; Hypoparathyroidism; Male; Parathyroid Glands; Postoperative Complications; Thyroidectomy; Transplantation, Autologous
PubMed: 32232629
DOI: 10.1007/s00405-020-05941-9 -
ANZ Journal of Surgery Sep 2021Intra-operative identification and preservation of parathyroid glands is an important but challenging aspect of thyroid surgery. Failure to do so may lead to transient... (Review)
Review
Intra-operative identification and preservation of parathyroid glands is an important but challenging aspect of thyroid surgery. Failure to do so may lead to transient or permanent hypocalcaemia, where the latter represents a serious complication causing life-long morbidity. It would be beneficial, therefore, if a simple and reliable modality can be developed to assist in the identification of parathyroid glands intra-operatively. The aim of this literature review is to provide an overview of intra-operative modalities used to identify parathyroid glands with a particular focus on near-infrared autofluorescence (NIRAF). Twenty-seven studies were considered relevant in this literature review. Several modalities have been used to aid parathyroid gland identification, including Raman spectroscopy, indocyanine green angiography, and NIRAF. NIRAF technology allows parathyroid glands to spontaneously give off light (autofluorescence) when exposed to near-infrared light at a wavelength of 785 nm, creating a contrast between tissues to allow intra-operative differentiation. Studies utilising NIRAF technology were able to identify 76.3%-100% of parathyroid glands intra-operatively. Furthermore, two randomised controlled trials comparing NIRAF and white light showed that the use of NIRAF was able to significantly increase the mean number of parathyroid glands detected and reduce the incidence of post-operative hypocalcaemia. NIRAF is an emerging tool that has been shown to increase the number of intra-operative parathyroid gland identification and reduce the rate of post-operative hypocalcaemia in a safe and reproducible manner. Future trials are needed to evaluate the real-life impact of NIRAF technology in outcomes of patients following thyroid surgery.
Topics: Humans; Optical Imaging; Parathyroid Glands; Parathyroidectomy; Thyroid Gland; Thyroidectomy
PubMed: 34414647
DOI: 10.1111/ans.17117 -
Surgical Pathology Clinics Mar 2023Parathyroid disease typically presents with parathyroid hyperfunction as result of neoplasia or a consequence of non-neoplastic systemic disease. Given the parathyroid... (Review)
Review
Parathyroid disease typically presents with parathyroid hyperfunction as result of neoplasia or a consequence of non-neoplastic systemic disease. Given the parathyroid gland is a hormonally active organ with broad physiologic implications and serologically accessible markers for monitoring, the diagnosis of parathyroid disease is predominantly a clinical pathologic correlation. We provide the current pathological correlates of parathyroid disease and discuss preoperative, intraoperative, and postoperative pathology consultative practice for optimal patient care.
Topics: Humans; Parathyroid Glands; Parathyroid Neoplasms; Parathyroid Hormone; Parathyroidectomy; Monitoring, Intraoperative
PubMed: 36739169
DOI: 10.1016/j.path.2022.10.001 -
International Journal of Hyperthermia :... 2022Hyperparathyroidism (HPT) is classified into primary HPT (PHPT), secondary HPT (SHPT), tertiary HPT (THPT), and pseudohyperparathyroidism. Parathyroid surgery is... (Review)
Review
BACKGROUND
Hyperparathyroidism (HPT) is classified into primary HPT (PHPT), secondary HPT (SHPT), tertiary HPT (THPT), and pseudohyperparathyroidism. Parathyroid surgery is generally reserved for patients with symptomatic PHPT and asymptomatic patients who meet the surgical guideline criteria. However, the risk of complications and mortality after parathyroid gland surgery increases with increasing patient age.
AIM
This study aimed to review existing research on laser ablation, radiofrequency ablation, microwave ablation, and high-intensity focused ultrasound in the treatment of HPT and analyze its application prospects.
CONCLUSIONS
Thermal ablation is a good alternative treatment for patients with parathyroid hyperplasia who do not meet the criteria or decline surgery. Being a type of minimally invasive treatment, ultrasound-guided thermal ablation has the advantages of easy operation, rapid recovery, and reusability and is used widely.
Topics: Humans; Hyperparathyroidism, Primary; Hyperparathyroidism, Secondary; Parathyroid Glands; Ultrasonography; Ultrasonography, Interventional
PubMed: 35271788
DOI: 10.1080/02656736.2022.2028907 -
Neuroimaging Clinics of North America Aug 2021Primary hyperparathyroidism results most commonly from a parathyroid adenoma, a benign parathyroid tumor that causes high levels of parathyroid hormone production. Given... (Review)
Review
Primary hyperparathyroidism results most commonly from a parathyroid adenoma, a benign parathyroid tumor that causes high levels of parathyroid hormone production. Given recent advances in surgical techniques allowing more focused, minimally invasive procedures, presurgical identification of candidate operative tissue has become increasingly useful in avoidance of 4-gland exploration. Imaging modalities for identification of parathyroid adenoma include ultrasonography, parathyroid scintigraphy, four-dimensional computed tomography, and magnetic resonance imaging. This article discusses technical and interpretive approaches for the available modalities, and reviews their strengths and weaknesses. Updates to the individual modalities and approaches for problem solving in lesion detection are also addressed.
Topics: Four-Dimensional Computed Tomography; Humans; Hyperparathyroidism, Primary; Parathyroid Glands; Radiopharmaceuticals; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon; Ultrasonography
PubMed: 34243872
DOI: 10.1016/j.nic.2021.04.007 -
Endocrinology and Metabolism (Seoul,... Oct 2022Parathyroidectomy is the treatment of choice for primary hyperparathyroidism when the clinical criteria are met. Although bilateral neck exploration is traditionally the... (Review)
Review
Parathyroidectomy is the treatment of choice for primary hyperparathyroidism when the clinical criteria are met. Although bilateral neck exploration is traditionally the standard method for surgery, minimally invasive parathyroidectomy (MIP), or focused parathyroidectomy, has been widely accepted with comparable curative outcomes. For successful MIP, accurate preoperative localization of parathyroid lesions is essential. However, no consensus exists on the optimal approach for localization. Currently, ultrasonography and technetium-99m-sestamibi-single photon emission computed tomography/computed tomography are widely accepted in most cases. However, exact localization cannot always be achieved, especially in cases with multiglandular disease, ectopic glands, recurrent disease, and normocalcemic primary hyperparathyroidism. Therefore, new modalities for preoperative localization have been developed and evaluated. Positron emission tomography/computed tomography and parathyroid venous sampling have demonstrated improvements in sensitivity and accuracy. Both anatomical and functional information can be obtained by combining these methods. As each approach has its advantages and disadvantages, the localization study should be deliberately chosen based on each patient's clinical profile, costs, radiation exposure, and the availability of experienced experts. In this review, we summarize various methods for the localization of hyperfunctioning parathyroid tissues in primary hyperparathyroidism.
Topics: Humans; Hyperparathyroidism, Primary; Parathyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Radiopharmaceuticals; Parathyroid Glands
PubMed: 36327985
DOI: 10.3803/EnM.2022.1589 -
The Journal of International Medical... Jan 2020In this review, parathyroid mass and its nonspecific symptoms are discussed. In daily clinical practice, patients present with varying symptoms, including depression,... (Review)
Review
In this review, parathyroid mass and its nonspecific symptoms are discussed. In daily clinical practice, patients present with varying symptoms, including depression, chest pain, pancreatitis, or nonspecific fatigue. If the patient is not tested for a parathyroid mass along with performing routine electrolyte tests, diagnosing such a patient with a parathyroid mass may take several years. This issue and situation are discussed in this review.
Topics: Cysts; Humans; Hyperparathyroidism; Parathyroid Glands; Parathyroid Neoplasms
PubMed: 30791798
DOI: 10.1177/0300060519827169