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Otolaryngologic Clinics of North America Feb 2024Postoperative hypoparathyroidism may cause significant patient morbidity and even mortality. Emerging technologies centered on autofluorescent properties of parathyroid... (Review)
Review
Postoperative hypoparathyroidism may cause significant patient morbidity and even mortality. Emerging technologies centered on autofluorescent properties of parathyroid glands when exposed to near-infrared light hold promise to improve surgical parathyroid gland identification and preservation. Two systems (probe-based and camera-based) are commercially available currently; however, neither system alone provides indication of vascular viability or postoperative parathyroid gland function. The administration of indocyanine green, when combined with near-infrared fluorescence imaging, enables subjective assessment of parathyroid gland perfusion. Additional technologies to assess parathyroid gland perfusion are being developed. The impact of these nascent technologies on relevant clinical outcomes is an area of active investigation.
Topics: Humans; Parathyroid Glands; Thyroidectomy; Hypoparathyroidism; Indocyanine Green; Optical Imaging
PubMed: 37634981
DOI: 10.1016/j.otc.2023.07.011 -
Seminars in Pediatric Surgery Apr 2014This review of parathyroid surgery in children will briefly discuss parathyroid gland embryology and anatomy before focusing on the pathophysiology, clinical... (Review)
Review
This review of parathyroid surgery in children will briefly discuss parathyroid gland embryology and anatomy before focusing on the pathophysiology, clinical presentation, and treatment of hyperparathyroidism in children. Hyperparathyroidism (HPT) is the overproduction of PTH and it is rare in children, with an incidence of 2-5 per 100,000. This rarity means that the principles of caring for children with parathyroid disease are largely extrapolated from the richer adult experience; however, the unique pediatric aspects of parathyroid problems and their surgical treatment, including presentation, imaging, operative approach, and complications, will be considered.
Topics: Child; Humans; Hyperparathyroidism; Parathyroid Glands; Parathyroidectomy; Perioperative Care; Treatment Outcome
PubMed: 24931350
DOI: 10.1053/j.sempedsurg.2014.03.003 -
Academic Radiology May 2023Gaps in primary hyperparathyroidism diagnosis are well-documented. End-organ damage correlates with disease duration and often occurs before diagnosis. We hypothesize...
RATIONALE AND OBJECTIVES
Gaps in primary hyperparathyroidism diagnosis are well-documented. End-organ damage correlates with disease duration and often occurs before diagnosis. We hypothesize that opportunistic parathyroid gland assessment on routine CT could decrease existing diagnosis gaps. Our purpose is to assess for enlarged parathyroid glands on contrast-enhanced CT acquired prior to biochemical screening and subsequent development of related morbidity.
MATERIALS AND METHODS
This retrospective study included consecutive patients with primary hyperparathyroidism undergoing parathyroidectomy with contrast-enhanced CT including the lower neck and upper chest acquired prior to biochemical screening. One neuroradiologist retrospectively evaluated all CTs for enlarged (estimated weight greater than 60 mg) parathyroid glands. Gold standard operative and pathology reports were correlated with CT findings, and medical records were reviewed for development of primary hyperparathyroidism-related comorbidities.
RESULTS
The sample comprised 38 patients (30 women, 8 men, median age 60 years) with 70 CTs of interest. The neuroradiologist identified 32 putative enlarged parathyroid glands (median estimated weight 307 mg) in 29 (76%) patients on CTs predating biochemical screening by a median of 30 months. Putative enlarged parathyroid glands on CT corresponded to pathologically proven parathyroid lesions in 26 (90%) patients. Of 26 patients with retrospectively identified pathologically proven parathyroid lesions, 12 (46%) developed at least 1 renal, bone, or neurocognitive comorbidity between CT and subsequent biochemical screening.
CONCLUSION
Enlarged parathyroid glands are frequently visible on routine CTs acquired years prior to primary hyperparathyroidism diagnosis. Biochemical screening based on enlarged glands could potentially prevent associated morbidity in almost half of such patients.
Topics: Male; Humans; Female; Middle Aged; Parathyroid Glands; Retrospective Studies; Hyperparathyroidism, Primary; Morbidity; Tomography, X-Ray Computed
PubMed: 35760712
DOI: 10.1016/j.acra.2022.05.014 -
Nuclear Medicine Review. Central &... 2019Mechanisms that are responsible for positive 99mTc-MIBI uptake in parathyroid glands are not clearly understood, some authors suggest there is a correlation between...
BACKGROUND
Mechanisms that are responsible for positive 99mTc-MIBI uptake in parathyroid glands are not clearly understood, some authors suggest there is a correlation between 99mTc MIBI accumulation and oxyphil cell content or parathyroid gland volume. The aim of our work was to assess the relationship between the pathological structure of parathyroids, their volume, oxyphil cell content and parathyroid 99mTc-MIBI retention.
MATERIAL AND METHODS
A total of 62 hyperfunctioning parathyroid glands in 46 patients were retrospectively analyzed. Preoperative 99mTc-MIBI scintigraphy was performed according to the double-phase and subtraction protocol. After surgery all glands were evaluated histologically, oxyphil cell content was assessed and volume of each excised gland was calculated.
RESULTS
Scintigraphy was positive in 41 of 62 parathyroid glands (66%). The median volume of positive glands was larger than that of negative glands (1.33 ml vs 0.7 ml, p = 0.015). Of the parathyroid lesions, there were 14 (22.6%) cases of nodular hyperplasia, 23 (37.1%) cases of diffuse hyperplasia, and 25 (40.3%) cases of adenomas. A high (≥ 25%) oxyphil cell content was found in 16 glands (25.8%) and a low ( < 25%) oxyphil cell content in 46 (74.2%) glands. Histopathology of parathyroid glands was related to the scintigraphy result (p = 0.002), but not to the 99mTc-MIBI uptake pattern (p = 0.868). The overall result of scintigraphy was not related to the oxyphil cell content (p = 0.797). 99mTc-MIBI uptake pattern wasn't related to the oxyphil cell content (p = 0.833). In general, parathyroid lesions with low oxyphil cell content were larger than parathyroid glands with high oxyphil cell content (1.33 ml vs 0.5 ml, respectively; p = 0.01). The median volume of parathyroids containing a high number of oxyphil cells and having a prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.62 ml vs 0.3 ml, respectively; p = 0.008). The median volume of parathyroids with low oxyphil cells content and showing prolonged 99mTc-MIBI retention was larger than those without prolonged 99mTc-MIBI retention (1.95 ml vs 1.07 ml, respectively; p = 0.014).
CONCLUSIONS
Our findings suggest that a positive scintigraphy result depends on parathyroid histopathology and gland volume and does not depend on the presence of oxyphil cells. Prolonged 99mTc-retention is not related to the parathyroid gland histopathology and the presence of oxyphil cells but to the gland volume.
Topics: Female; Humans; Male; Middle Aged; Organ Size; Oxyphil Cells; Parathyroid Glands; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Sestamibi
PubMed: 31482540
DOI: 10.5603/NMR.2019.0005 -
British Journal of Hospital Medicine... Jun 2021
Topics: Humans; Mediastinal Neoplasms; Mediastinum; Parathyroid Glands; Parathyroid Neoplasms; Renal Dialysis
PubMed: 34191572
DOI: 10.12968/hmed.2020.0599 -
The Surgical Clinics of North America Aug 2019This article reviews intraoperative decision making related to several important aspects of parathyroid surgery. These include how to systematically identify a missing... (Review)
Review
This article reviews intraoperative decision making related to several important aspects of parathyroid surgery. These include how to systematically identify a missing gland, when to perform a unilateral versus bilateral exploration for cure, approaches to secondary hyperparathyroidism, management of familial hyperparathyroidism, and the treatment of parathyroid cancer. The management of intraoperative complications, such as recurrent laryngeal nerve injury and devascularization of parathyroid glands, also is discussed.
Topics: Decision Making; Humans; Hyperparathyroidism, Primary; Intraoperative Period; Parathyroid Glands; Parathyroidectomy
PubMed: 31255199
DOI: 10.1016/j.suc.2019.04.008 -
Horumon To Rinsho. Clinical... May 1973
Review
Topics: Animals; Calcium; Cattle; Culture Techniques; Magnesium; Parathyroid Glands; Parathyroid Hormone; Radioimmunoassay; Rats
PubMed: 4581096
DOI: No ID Found -
Frontiers in Endocrinology 2023In thyroid surgery, autofluorescence allows the parathyroid glands (PTGs) to be located very early to protect them. Moreover, indocyanine green (ICG) fluorescence...
BACKGROUND
In thyroid surgery, autofluorescence allows the parathyroid glands (PTGs) to be located very early to protect them. Moreover, indocyanine green (ICG) fluorescence angiography (ICG-FA) allows for assessing the viability of the PTGs and identifying blood vessels to preserve them. The main limitation of using ICG-FA is that once ICG has been injected, it is no longer possible to observe PTG autofluorescence using existing devices. This study aimed to describe an approach that allows for visualization of the PTGs by autofluorescence, even after ICG injection.
METHODS
We redesigned the FLUOBEAM® LX system to excite fluorescence at 685 nm and detect fluorescence between 700 and 900 nm. This device had short-pass filters at 775 nm that helped to split the contributions of the PTG autofluorescence and ICG fluorescence. Tests were performed on extemporaneous PTG preparations placed next to ICG droplets to assess for rejection of the ICG signal.
RESULTS
A low-pass filter at 775 nm detected 60% of the autofluorescence signals and 10% of the ICG signals.
CONCLUSION
These findings support the possibility of visualizing PTG autofluorescence despite multiple ICG injections and measuring the balance between ICG and autofluorescence signals.
Topics: Parathyroid Glands; Fluorescein Angiography; Indocyanine Green; Thyroidectomy; Feasibility Studies; Optical Imaging
PubMed: 38027151
DOI: 10.3389/fendo.2023.1248449 -
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 -
Neuroimaging Clinics of North America Aug 2008The most common indication for parathyroid imaging is hyperparathyroidism, which is caused by a solitary parathyroid adenoma in most patients. The primary function of... (Review)
Review
The most common indication for parathyroid imaging is hyperparathyroidism, which is caused by a solitary parathyroid adenoma in most patients. The primary function of parathyroid imaging is localization of the abnormal parathyroid gland, enabling the surgeon to pursue a minimally invasive resection. Ultrasound and (99m)Tc sestamibi scintigraphy are the mainstays for the preoperative localization of culprit lesions. The emerging modality of SPECT-CT can improve the sensitivity of (99m)Tc sestamibi scintigraphy and its use is encouraged when available. CT and MR imaging are useful as adjuncts, particularly as anatomic correlates to suspected ectopic glands on (99m)Tc sestamibi scintigraphy that are inaccessible to ultrasound. In cases of suspected parathyroid carcinoma, preoperative CT or MR imaging is recommended for surgical planning.
Topics: Humans; Magnetic Resonance Imaging; Parathyroid Diseases; Parathyroid Glands; Parathyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Ultrasonography
PubMed: 18656034
DOI: 10.1016/j.nic.2008.03.006