-
Gland Surgery Sep 2023Accurate intraoperative identification and viability assessment of the parathyroid glands (PGs) has always been a crucial but challenging aspect of thyroid surgery. The... (Review)
Review
BACKGROUND AND OBJECTIVE
Accurate intraoperative identification and viability assessment of the parathyroid glands (PGs) has always been a crucial but challenging aspect of thyroid surgery. The traditional method, naked-eye (NE) assessment, is significantly associated with the experience of the surgeon. Therefore, various methods have been developed to help surgeons protect PGs, with some benefits and limitations. Recently, near-infrared autofluorescence (NIRAF) and indocyanine green fluorescence imaging (ICGFI) have been demonstrated to be promising in the identification and viability assessment of PGs. Herein, we provide an overview of the methods of intraoperative identification and viability assessment of PGs, focusing on the application of NIRAF and ICGFI.
METHODS
We performed a systematic literature search of PubMed, Medline, Cochrane Library databases, Web of Science, and EMBASE to identify all relevant studies published up to March 2023. The keywords were ((autofluorescence) OR (indocyanine green)) AND (parathyroid gland).
KEY CONTENT AND FINDINGS
In this narrative review, we summarized the benefits and limitations of intraoperative methods for PG identification and viability assessment, focusing on the application of NIRAF and ICGFI.
CONCLUSIONS
Intraoperative parathyroid protection methods have developed from traditional subjective identification of PGs to the latest near-infrared (NIR) fluorescence imaging technology. The discovery, development, and application of NIRAF and ICGFI have provided better ways for surgeons to protect PGs intraoperatively.
PubMed: 37842534
DOI: 10.21037/gs-23-242 -
World Journal of Surgical Oncology Jan 2021Primary hyperparathyroidism is an endocrine pathology that affects calcium metabolism. Patients with primary hyperparathyroidism have high concentrations of serum...
BACKGROUND
Primary hyperparathyroidism is an endocrine pathology that affects calcium metabolism. Patients with primary hyperparathyroidism have high concentrations of serum calcium or high concentrations of parathyroid hormone, or incorrect parathyroid hormone levels for serum calcium values. Primary hyperparathyroidism is due to the presence of an adenoma/single-gland disease in 80-85%. Multiple gland disease or hyperplasia accounts for 10-15% of cases of primary hyperparathyroidism. Atypical parathyroid adenoma and parathyroid carcinoma are both responsible for about 1.2-1.3% and 1% or less of primary hyperparathyroidism, respectively.
METHODS
We performed a retrospective cohort study and enrolled 117 patients with primary hyperparathyroidism undergoing minimally invasive parathyroidectomy. Histological and immunohistochemical examination showed that 107 patients (91.5%) were diagnosed with typical adenoma (group A), while 10 patients (8.5%) were diagnosed with atypical parathyroid adenoma (group B). None of the patients were affected by parathyroid carcinoma.
RESULTS
Significant statistical differences were found in histological and immunohistochemical parameters as pseudocapsular invasion (p < 0.001), bands of fibrosis (p < 0.001), pronounced trabecular growth (p < 0.001), mitotic rates of > 1/10 high-power fields (HPFs) (p < 0.001), nuclear pleomorphism (p = 0.036), thick capsule (p < 0.001), Ki-67+ > 4% (p < 0.001), galectin-3 + (p = 0.002), and protein gene product (PGP) 9.5 + (p = 0.038).
CONCLUSIONS
Atypical parathyroid adenoma is a tumor that has characteristics both of typical adenoma and parathyroid carcinoma. The diagnosis is reached by excluding with strict methods the presence of malignancy criteria. Atypical parathyroid adenoma compared to typical adenoma showed significant clinical, hematochemical, histological, and immunohistochemical differences. We did not find any disease relapse in the 10 patients with atypical parathyroid adenoma during 60 months of follow-up time.
Topics: Adenoma; Humans; Parathyroid Glands; Parathyroid Hormone; Parathyroid Neoplasms; Parathyroidectomy; Prognosis; Retrospective Studies
PubMed: 33472651
DOI: 10.1186/s12957-021-02123-7 -
Asian Journal of Surgery Jan 2022To investigate how number of autotransplanted parathyroid glands (PGs) affects the incidence of postoperative hypoparathyroidism and the recovery of parathyroid function. (Review)
Review
BACKGROUND
To investigate how number of autotransplanted parathyroid glands (PGs) affects the incidence of postoperative hypoparathyroidism and the recovery of parathyroid function.
METHODS
A systematic search was performed in the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases. The evaluated indices included the incidence of postoperative transient and permanent hypoparathyroidism and parathyroid hormone (PTH) levels during follow-up.
RESULTS
Twenty articles with 7291 patients were included. A higher incidence of transient hypoparathyroidism was found in the PG autotransplantation group than in the preservation group (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.90, 2.96). However, there was no significant difference between the two groups regarding permanent hypoparathyroidism (OR: 1.17; 95% CI: 0.71, 1.91). Parathyroid hormone (PTH) levels in the PG autotransplantation group changed significantly more than the preservation group at postoperative 1-day and 1-month, but became similar at the 6-month, 1-year and 2-year follow-up. Autotransplantation of 2 and 3 PGs demonstrated a higher incidence of transient hypoparathyroidism than 1 PG (OR: 2.09; 95% CI: 1.41, 3.11 and OR: 9.70; 95% CI: 2.11, 44.39, respectively), but no significant difference was observed between the autotransplantation of 3 and 2 PGs (OR: 0.99; 95% CI: 0.03, 29.06). Additionally, the incidence of permanent hypoparathyroidism was not significantly different when different number of PGs was autotransplanted.
CONCLUSIONS
PG autotransplantation is an effective mid- and long-term strategy for the preservation of parathyroid function. Although transient hypoparathyroidism was positively correlated with the number of autotransplanted PGs, no remarkable correlation was observed for permanent hypoparathyroidism.
Topics: Humans; Hypoparathyroidism; Parathyroid Glands; Parathyroid Hormone; Postoperative Complications; Thyroidectomy; Transplantation, Autologous
PubMed: 33863630
DOI: 10.1016/j.asjsur.2021.03.031 -
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 -
Nature Communications Feb 2022Parathyroid hormone (PTH) plays crucial role in maintaining calcium and phosphorus homeostasis. In the progression of secondary hyperparathyroidism (SHPT), expression of...
Parathyroid hormone (PTH) plays crucial role in maintaining calcium and phosphorus homeostasis. In the progression of secondary hyperparathyroidism (SHPT), expression of calcium-sensing receptors (CaSR) in the parathyroid gland decreases, which leads to persistent hypersecretion of PTH. How to precisely manipulate PTH secretion in parathyroid tissue and underlying molecular mechanism is not clear. Here, we establish an optogenetic approach that bypasses CaSR to inhibit PTH secretion in human hyperplastic parathyroid cells. We found that optogenetic stimulation elevates intracellular calcium, inhibits both PTH synthesis and secretion in human parathyroid cells. Long-term pulsatile PTH secretion induced by light stimulation prevented hyperplastic parathyroid tissue-induced bone loss by influencing the bone remodeling in mice. The effects are mediated by light stimulation of opsin expressing parathyroid cells and other type of cells in parathyroid tissue. Our study provides a strategy to regulate release of PTH and associated bone loss of SHPT through an optogenetic approach.
Topics: Bone and Bones; Calcium; Homeostasis; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Hyperplasia; Optogenetics; Parathyroid Glands; Parathyroid Hormone; Receptors, Calcium-Sensing
PubMed: 35140213
DOI: 10.1038/s41467-022-28472-9 -
International Journal of Surgery Case... Jan 2022The ectopic parathyroid adenoma is an important cause of refractory and recurrent hyperparathyroidism. The mediastinal location of ectopic parathyroid tissue is reported...
INTRODUCTION AND IMPORTANCE
The ectopic parathyroid adenoma is an important cause of refractory and recurrent hyperparathyroidism. The mediastinal location of ectopic parathyroid tissue is reported in up to 20% of cases of ectopic parathyroid adenomas. In around 2% of cases where cervical approach is unfeasible, the mediastinal route imposes a surgical challenge.
CASE PRESENTATION
We describe a case of a twenty-five-year-old male patient with manifestations of hyperparathyroidism. Computed tomography of the chest showed an anterior mediastinal mass. Nuclear scintigraphy detected a functioning parathyroid tissue in the mediastinum. The mass was excised en block with the surrounding adipose tissue using a three-port video-assisted thoracoscopic surgery. The patient showed a full symptomatic and laboratory recovery.
CLINICAL DISCUSSION
Mediastinal parathyroid glands comprise a unique surgical entity with diagnostic and management difficulties.
CONCLUSION
Mediastinal parathyroid gland is a rare yet important cause of refractory hypercalcemia. The current localization tools improve the thoracoscopic management of MPAs. VATS can provide access and exposure to ectopic parathyroid adenoma with low morbidity.
PubMed: 34896776
DOI: 10.1016/j.ijscr.2021.106598 -
Sisli Etfal Hastanesi Tip Bulteni 2023Postoperative hypoparathyroidism is a common complication following thyroidectomy, with the potential for significant morbidity and cost. While various techniques have...
OBJECTIVES
Postoperative hypoparathyroidism is a common complication following thyroidectomy, with the potential for significant morbidity and cost. While various techniques have been proposed for intraoperative parathyroid gland (PG) identification and preservation, indocyanine green (ICG) angiography has emerged as a promising method. In this retrospective study, patients who underwent total thyroidectomy with or without central neck dissection were evaluated for the utility of ICG angiography in identifying PGs and the correlation of ICG scores with postoperative parathyroid function.
METHODS
ICG angiography was performed using a standardized protocol, and the degree of PG vascularization was assessed visually. A scoring system was employed based on ICG uptake intensity in PGs, as described in the literature. Pearson's correlation test examined the relationship between the total ICG score and percentage parathyroid hormone (PTH) gradient, postoperative calcium, and PTH levels. In addition, patients with at least one well-vascularized PG were also evaluated.
RESULTS
Twenty-two patients were included in the study. Significant positive correlations were found between the total ICG score and postoperative PTH levels (r=0.549, p=0.008), and a negative correlation with the percentage of PTH gradient (r=-0.504, p=0.01). However, six patients with well-vascularized PGs on ICG angiography still developed postoperative hypoparathyroidism.
CONCLUSION
ICG angiography offers a potential tool for evaluating PG vascularization during thyroidectomy and predicting the risk of postoperative hypoparathyroidism. However, its application should be used judiciously, and the technique should be improved for PG preservation. Further studies are warranted to better understand its benefits and limitations in thyroid surgery.
PubMed: 38268654
DOI: 10.14744/SEMB.2023.06691 -
PloS One 2020Ultrasonographic examination of the normal thyroid and parathyroid glands has been described for humans and many animal species. However, similar reports for goats are...
Ultrasonographic examination of the normal thyroid and parathyroid glands has been described for humans and many animal species. However, similar reports for goats are still missing. The aim of the study was to present ultrasound features of the normal thyroid and internal parathyroid glands in goats with the determination of their dimensions and volume, followed by a comparison of the results to the gross examination. Seventy-two goats were used in the study. The echostructure and echogenicity of the thyroid and parathyroid glands were assessed. The length, width and height of the thyroid and the length and width of the parathyroid glands were measured. The thyroid volume was calculated using the ellipsoid formula, basing on the ultrasonographic dimensions. Size and volume of the dissected thyroid glands were established grossly, followed by a histological examination. In order to accurately describe the anatomy of the thyroid, new anatomical terminology characterizing this gland was proposed. The mean dimensions of the thyroid lobes were 30.2 x 10.5 x 6.3 mm. There were no statistically significant differences between the right and left lobe. Parathyroid glands measured an average of 3.6 x 2.4 mm. The percentage Root Mean Square Error between the results of ultrasonographic and gross examination was 16.73%, 20.65% and 17.01% for thyroid length, width and height, respectively, and 46.30% for volume. In order to obtain more precise calculation of the thyroid volume, a modified correction factor for the ellipsoid formula was introduced. For the first time, the normal ultrasonographic characteristics and dimensions of the caprine thyroid and internal parathyroid glands were presented. The results may serve as a radiological reference and be the basis for further research.
Topics: Animals; Female; Goats; Parathyroid Glands; Thyroid Gland; Ultrasonography
PubMed: 32470047
DOI: 10.1371/journal.pone.0233685 -
International Journal of Molecular... Jun 2020Secondary hyperparathyroidism (SHP) is a common complication of chronic kidney disease (CKD) that correlates with morbidity and mortality in uremic patients. It is... (Review)
Review
Secondary hyperparathyroidism (SHP) is a common complication of chronic kidney disease (CKD) that correlates with morbidity and mortality in uremic patients. It is characterized by high serum parathyroid hormone (PTH) levels and impaired bone and mineral metabolism. The main mechanisms underlying SHP are increased PTH biosynthesis and secretion as well as increased glandular mass. The mechanisms leading to parathyroid cell proliferation in SHP are not fully understood. Reduced expressions of the receptors for calcium and vitamin D contribute to the disinhibition of parathyroid cell proliferation. Activation of transforming growth factor-α-epidermal growth factor receptor (TGF-α-EGFR), nuclear factor kappa B (NF-kB), and cyclooxygenase 2- prostaglandin E2 (Cox2-PGE2) signaling all correlate with parathyroid cell proliferation, underlining their roles in the development of SHP. In addition, the mammalian target of rapamycin (mTOR) pathway is activated in parathyroid glands of experimental SHP rats. Inhibition of mTOR by rapamycin prevents and corrects the increased parathyroid cell proliferation of SHP. Mice with parathyroid-specific deletion of all miRNAs have a muted increase in serum PTH and fail to increase parathyroid cell proliferation when challenged by CKD, suggesting that miRNA is also necessary for the development of SHP. This review summarizes the current knowledge on the mechanisms of parathyroid cell proliferation in SHP.
Topics: Cell Proliferation; Down-Regulation; Fibroblast Growth Factor-23; Humans; Hyperparathyroidism, Secondary; Parathyroid Glands; Receptors, Calcitriol; Receptors, Calcium-Sensing; Renal Insufficiency, Chronic
PubMed: 32570711
DOI: 10.3390/ijms21124332 -
Archives of Endocrinology and Metabolism Jun 2021
Topics: Cicatrix; Humans; Parathyroid Glands; Thyroid Gland; Thyroidectomy
PubMed: 34191416
DOI: 10.20945/2359-3997000000381