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Gland Surgery Dec 2021This study sought to establish a rat model of hypoparathyroidism by removing the rat parathyroid glands, and compare the effects of different transplantation sites and...
BACKGROUND
This study sought to establish a rat model of hypoparathyroidism by removing the rat parathyroid glands, and compare the effects of different transplantation sites and transplantation methods using a primary culture of parathyroid cells on the hormone secretion of the model rats.
METHODS
Male Sprague Dawley (SD) rats were selected for parathyroid gland removal, and rats with abnormal postoperative water intake, weight gain, parathyroid hormone (PTH), and blood calcium ion concentration were selected as transplant recipients and divided into the model group, brachioradialis muscle cell transplantation group, gelatin sponge group, and subcutaneous transplantation group. The parathyroid tissue was removed and the primary cell culture was performed using homozygous SD rats as graft donors. When the parathyroid cells were able to secrete PTH, transplantation was performed, and the postoperative recovery of the PTH function of the rats with different transplantation sites and methods were observed.
RESULTS
A recipient model with low PTH was successfully established, and parathyroid progenitor cells with obvious PTH secretion were obtained. Better secretion was observed in the brachioradialis cell group compare with other groups.
CONCLUSIONS
The primary cell culture of the donor parathyroid cells combined with cell transplantation significantly improved the physiological function of the hypoparathyroid rats, and could potentially replace traditional clinical brachioradialis muscle tissue transplantation.
PubMed: 35070900
DOI: 10.21037/gs-21-809 -
Polish Journal of Pathology : Official... 2021Advances in laboratory diagnostics and surgical treatment of primary hyperparathyroidism have ensured solid basis for research in parathyroid pathology in order to...
Advances in laboratory diagnostics and surgical treatment of primary hyperparathyroidism have ensured solid basis for research in parathyroid pathology in order to specify key molecules in pathogenesis and morphological diagnostics of difficult cases. The aim of this study was to assess the molecular landscape and its heterogeneity in primary parathyroid hyperplasia (PPH) and adenoma, compared to carcinoma and normal glands. In a retrospective analysis of 179 surgically removed parathyroid glands (102 adenomas; 27 PPH; 45 normal glands; 5 carcinomas), expression of Ki-67, p21, p27, p53, cyclin D1, Bcl-2 protein, vimentin, cytokeratin (CK) 19, E-cadherin, CD56, CD44 and parafibromin was detected by immunohistochemistry, followed by computer-assisted assessment of mean values and heterogeneity measures. Descriptive statistics and Kruskal-Wallis test were applied. Significant differences were disclosed regarding the mean and highest fraction of Ki-67 (both p < 0.001), p21 (both p < 0.001), cyclin D1 (p = 0.002) and p27-expressing cells (p = 0.010). Proliferative lesions (PPH, adenoma and carcinoma) showed statistically significantly up-regulated CK19 (p = 0.012), decreased E-cadherin levels and distinctive patterns of vimentin. CD44, CD56 and p53 were almost absent from parathyroid tissues. All carcinomas lacked parafibromin contrasting with invariable positivity in adenomas. Remarkable heterogeneity of cell cycle markers and intermediate filaments must be accounted for in scientific studies and elaboration of diagnostic cut-offs.
Topics: Adenoma; Carcinoma; Humans; Parathyroid Glands; Parathyroid Neoplasms; Retrospective Studies
PubMed: 34706517
DOI: 10.5114/pjp.2021.109513 -
Frontiers in Endocrinology 2023To evaluate the safety and efficacy of autologous parathyroid transplantation in laparoscopic total thyroidectomy combined with central lymph node dissection (CLND).
PURPOSE
To evaluate the safety and efficacy of autologous parathyroid transplantation in laparoscopic total thyroidectomy combined with central lymph node dissection (CLND).
METHODS
Retrospective analysis of clinical data of 152 patients admitted to the General Surgery Department of Gansu Provincial People's Hospital who underwent endoscopic total thyroidectomy combined with CLND from June 2018 to December 2021. The intraoperative parathyroid glands were divided into the orthotopic preservation group (non-transplantation group) and the immediate active autologous transplantation group (transplantation group) according to the different treatment management of parathyroid glands during operation. The levels of Ca2+ in parathyroid blood and the incidence of hypoparathyroidism were compared between the two groups before operation and 1 day, 3 day, 1 week, 1 month, 3 months and 6 months after operation.
RESULTS
There was no significant difference in PTH between the preoperative transplantation group compared and the non-transplantation group (P>0.05); The PTH in the transplantation group was lower than that of the non-transplantation group 1 and 3 d after surgery, and the difference was statistically significant (P<0.05); No statistically significant difference in PTH between patients in the transplantation group compared with those in the non-transplantation group at 1 week postoperatively (P>0.05); PTH was significantly higher in the transplant group than in the non-transplant group at 1, 3 and 6 months after surgery, with statistically significant differences (P<0.05); there was no statistically differences (P>0.05) in serum Ca between the preoperative, 1d, 3d and 1 week postoperative transplantation group and the non-transplantation group; Blood Ca was significantly higher in the transplant group than in the non-transplant group at 1, 3 and 6 months after surgery, with statistically significant differences (P<0.05); The rate of temporary hypoparathyroidism in the transplantion group was higher than that in the non-transplantion group, and the rate of permanent hypoparathyroidism was lower than that in the non-transplantion group (P=0.044); There was no significant difference in the concentration of PTH in the cephalic vein of the elbow between the transplanted side and the non-transplanted side at 1 day and 3 days postoperatively (P>0.05); the concentration of PTH in cephalic vein of the elbow was significantly higher than that in non-transplanted side at 1 week, 1 month, 3 months and 6 months postoperatively (P<0.001); the number central area dissection and metastasis dissection in the transplantation group were significantly higher than those in the non-transplantation group (P<0.05).
CONCLUSIONS
Most autologous parathyroid glands, having functional parathyroid autograft, is helpful to the occurrence of hypoparathyroidism after endoscopic total thyroidectomy with CLND, and it is an effective strategy to prevent permanent hypoparathyroidism, and more thorough area dissection is beneficial to the disease prognosis.
Topics: Humans; Parathyroid Glands; Transplantation, Autologous; Thyroidectomy; Retrospective Studies; Hypoparathyroidism; Laparoscopy
PubMed: 37441504
DOI: 10.3389/fendo.2023.1193851 -
Langenbeck's Archives of Surgery Oct 2023Despite advances in biochemical and radiological identification of parathyroid gland enlargement, primary hyperparathyroidism (PHPT) due to sporadic multigland... (Review)
Review
BACKGROUND
Despite advances in biochemical and radiological identification of parathyroid gland enlargement, primary hyperparathyroidism (PHPT) due to sporadic multigland parathyroid disease (MGPD) remains a perioperative diagnostic dilemma. Failure to recognise MGPD pre- or intraoperatively may negatively impact surgical cure rates and result in persistent PHPT and ongoing patient morbidity.
METHODS
We have conducted a comprehensive review of published literature in attempt to determine factors that could aid in reliably diagnosing sporadic MGPD pre- or intraoperatively. We discuss preoperative clinical features and examine pre- and intraoperative biochemical and imaging findings concentrating on those areas that give practicing surgeons and the wider multi-disciplinary endocrine team indications that a patient has MGDP. This could alter surgical strategy.
CONCLUSION
Biochemistry can provide diagnosis of PHPT but cannot reliably discriminate parathyroid pathology. Histopathology can aid diagnosis between MGPD and adenoma, but histological appearance can overlap. Multiple negative imaging modalities indicate that MGPD may be more likely than a single parathyroid adenoma, but the gold standard for diagnosis is still intraoperative identification during BNE. MGPD remains a difficult disease to both diagnose and treat.
Topics: Humans; Parathyroid Hormone; Parathyroidectomy; Parathyroid Diseases; Parathyroid Glands; Parathyroid Neoplasms; Hyperparathyroidism, Primary; Retrospective Studies
PubMed: 37806985
DOI: 10.1007/s00423-023-03087-w -
BMJ Case Reports Oct 2020Parathyroid cysts are rare lesions of the cervical region and less frequently of the mediastinum. They occur mostly in women and are usually asymptomatic. They generally...
Parathyroid cysts are rare lesions of the cervical region and less frequently of the mediastinum. They occur mostly in women and are usually asymptomatic. They generally occur in the fourth and fifth decades of life and mainly are non-functioning. They commonly present as a neck mass that is found incidentally during surgery or in imaging test. Its importance lies in the difficulty in diagnosis, often confusing itself with thyroid pathology. The diagnosis is usually made intraoperatively, confirmed by histopathological examination.The aim of this paper is to report a case of parathyroid cyst that mimics a thyroid nodule.
Topics: Adult; Biopsy, Fine-Needle; Cysts; Diagnosis, Differential; Humans; Incidental Findings; Male; Parathyroid Diseases; Parathyroid Glands; Parathyroidectomy; Peritonsillar Abscess; Tomography, X-Ray Computed
PubMed: 33040031
DOI: 10.1136/bcr-2019-232017 -
Renal Failure Dec 2021The purpose of the current study was to determine the performance of contrast-enhanced ultrasound (CEUS) in the assessment of radiofrequency ablation (RFA) of...
OBJECTIVES
The purpose of the current study was to determine the performance of contrast-enhanced ultrasound (CEUS) in the assessment of radiofrequency ablation (RFA) of hyperplastic parathyroid glands due to secondary hyperparathyroidism (SHPT).
METHODS
Thirty-two patients, each with ≥4 hyperplastic parathyroid glands due to SHPT, underwent RFA hydro-dissection. CEUS was performed in each patient before and during RFA. The patients in whom the intact parathyroid hormone (iPTH) level did not decrease to 300 pg/ml were examined by CEUS. The iPTH, serum calcium, and serum phosphorus levels before and after RFA were compared.
RESULTS
Ablation was achieved in all patients (131 ablated glands). The volume of the glands was 479.88 ± 549.3mm. The pre-operative and day 1 post-operative iPTH levels were 2355 ± 1062 and 292.7 ± 306.8 pg/ml, respectively. Three nodules in three patients showed little enhancement on CEUS on post-operative day 1. The iPTH level was <300 pg/mL on post-operative day 1 in 23 patients, which indicated complete ablation; follow-up evaluations were therefore performed. The pre- and post-operative iPTH levels in the 23 patients were 2113 ± 787.2 and 106.2 ± 84.62 pg/ml, respectively ( < 0.05), and the 6- and 12-month post-operative iPTH levels were 111.1 ± 56.57 and 117.6 ± 97.08 pg/ml, respectively ( > 0.05).
CONCLUSIONS
CEUS-guided RFA is effective and feasible for the treatment of ≥4 hyperplastic parathyroid glands. CEUS was shown to assist the surgeon before, during, and after RFA. CEUS on post-operative day 2, but not immediately post-operatively, was shown to accurately reflect gland perfusion.
Topics: Adult; Aged; Calcium; Feasibility Studies; Female; Humans; Hyperparathyroidism, Secondary; Male; Middle Aged; Parathyroid Glands; Parathyroid Hormone; Phosphorus; Radiofrequency Ablation; Renal Dialysis; Renal Insufficiency, Chronic; Treatment Outcome; Ultrasonography, Doppler
PubMed: 33663332
DOI: 10.1080/0886022X.2021.1889601 -
Journal of Taibah University Medical... Apr 2022Hypocalcaemia and hypoparathyroidism are the most frequent complications of total thyroidectomy that may result in the need for lifelong calcium supplementation. This...
OBJECTIVES
Hypocalcaemia and hypoparathyroidism are the most frequent complications of total thyroidectomy that may result in the need for lifelong calcium supplementation. This study aims to investigate the impact of incidental parathyroidectomy on short- and long-term hypocalcaemia.
METHODS
This retrospective study was conducted on patients who underwent total thyroidectomy with or without central neck dissection between March 2016 to May 2018. All procedures were performed by three surgeons with similar experience levels. Histopathology reports were reviewed, the number of resected parathyroid glands and the underlying pathology reports were recorded, and the patients were divided into two groups; groups A and B comprised those with and without parathyroid glands respectively. The incidence rates of short- and long-term hypocalcaemia were recorded. The former was obtained through blood tests during hospitalisation and the latter via phone calls to patients 3, 6, and 12 months postoperatively.
RESULTS
A total of 116 patients participated, 18 (15.5%) in group A and 98 (84.5%) in group B. No statistical significance was detected between the two groups regarding early postoperative ( = 0.109) or long-term hypocalcaemia ( = 0.48). These results were similar in patients with cancer (n = 40) ( = 0.855, = 0.08).
CONCLUSION
Incidental parathyroidectomy of one parathyroid gland was not correlated with a higher incidence of hypocalcaemia, even in cases with thyroid cancer.
PubMed: 35592801
DOI: 10.1016/j.jtumed.2021.08.001 -
Langenbeck's Archives of Surgery Feb 2022Systematic identification of all 4 parathyroid glands has been recommended during total thyroidectomy (TT); however, it is unclear whether this strategy necessarily...
PURPOSE
Systematic identification of all 4 parathyroid glands has been recommended during total thyroidectomy (TT); however, it is unclear whether this strategy necessarily translates into optimized functional parathyroid preservation. We wished to investigate the association between number of parathyroids identified intraoperatively during TT, and incidence of incidental parathyroidectomy, and postoperative hypoparathyroidism.
METHODS
Retrospective review of prospectively maintained database of 511 consecutive patients undergoing TT at an academic teaching hospital. The association between number of parathyroid glands identified intraoperatively and incidence of biochemical hypocalcaemia (defined as any calcium < 2 mmol/L n first 48 h after surgery), symptomatic hypocalcaemia; permanent hypoparathyroidism (defined as any hypocalcaemia or need for calcium or vitamin D > 6 months after surgery), and incidental parathyroidectomy, was investigated. The association between number of parathyroid glands visualized and postoperative parathyroid hormone (PTH) levels was investigated in a subset of 454 patients.
RESULTS
Patients in whom a greater number of parathyroids had been identified had a significantly higher incidence of biochemical and symptomatic hypocalcaemia, and significantly lower postoperative PTH levels, than patients with fewer glands identified. There were no significant differences in incidence of permanent hypoparathyroidism or incidental parathyroidectomy. On multivariate analysis, malignancy, Graves disease, and identification of 3-4 parathyroids were independent predictors of biochemical hypocalcaemia. For symptomatic hypocalcaemia, identification of 2-4 parathyroids, and identification of 3-4 parathyroids, were significant.
CONCLUSIONS
Systematic identification of as many parathyroid glands as possible during TT is not necessary for functional parathyroid preservation.
Topics: Calcium; Humans; Hypocalcemia; Hypoparathyroidism; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Postoperative Complications; Thyroidectomy
PubMed: 34406491
DOI: 10.1007/s00423-021-02287-6 -
Interactive Cardiovascular and Thoracic... Jun 2021The most frequent cause of suboptimal results in a parathyroid adenoma resection is an ectopic location, mainly in the anterior mediastinum. These cases may not always...
The most frequent cause of suboptimal results in a parathyroid adenoma resection is an ectopic location, mainly in the anterior mediastinum. These cases may not always be resected through a traditional cervical access. We present 2 cases of primary hyperparathyroidism who underwent an unsuccessful bilateral cervical exploration due to parathyroid tissue located inside the thymic gland. A video-assisted thoracoscopic surgery thymectomy with intraoperative determination of blood parathormone levels was performed. A 50% reduction of intraoperatory parathyroid hormone blood from the highest basal level at 5 and 10 min after resection was obtained. Final pathological results showed an intra-thymic parathyroid adenoma in the first patient and an intra-thymic focus of parathyroid hyperplasia in the second patient. In conclusion, video-assisted thoracoscopic surgery thymectomy could be the optimal approach to resect ectopic parathyroid adenomas located in the anterior mediastinum.
Topics: Adenoma; Humans; Mediastinum; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy
PubMed: 33893507
DOI: 10.1093/icvts/ivab043 -
BMJ Case Reports Feb 2021Ectopic or supernumerary parathyroid tissue has been generally described in the literature in cases found during workup for parathyroid adenoma. We present two unique...
Ectopic or supernumerary parathyroid tissue has been generally described in the literature in cases found during workup for parathyroid adenoma. We present two unique cases of intratracheal parathyroid gland, a rare occurrence that has not yet been described in the literature. In both cases, the masses were found incidentally and showed no clinical or laboratory evidence of hyperparathyroidism. In both cases, surveillance was chosen as the method of treatment. We present this case series to increase awareness of this potential diagnosis.
Topics: Adult; Aged; Female; Humans; Male; Parathyroid Glands; Parathyroid Neoplasms; Trachea; Treatment Outcome
PubMed: 33579799
DOI: 10.1136/bcr-2020-239435