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The Journal of Surgical Research Jan 2017Primary hyperparathyroidism (pHPT) is commonly treated with targeted parathyroidectomy (PTX) guided by preoperative imaging and intraoperative parathormone monitoring....
BACKGROUND
Primary hyperparathyroidism (pHPT) is commonly treated with targeted parathyroidectomy (PTX) guided by preoperative imaging and intraoperative parathormone monitoring. Despite advanced imaging techniques, failure of parathyroid localization still occurs. This study determines the anatomical distribution of single abnormal parathyroid glands, which may help direct the surgeon in PTX when preoperative localization is unsuccessful.
METHODS
A retrospective review of prospectively collected data of 810 patients with pHPT who underwent initial PTX at a tertiary medical center was performed. All patients had biochemically confirmed pHPT and single-gland disease. Abnormal parathyroid gland localization was determined at time of operation, correlated with operative and pathology reports, and confirmed by operative success defined as eucalcemia for ≥6 mo after PTX. Patients with multiple endocrine neoplasia, secondary, tertiary, or familial hyperparathyroidism, multiglandular disease, parathyroid cancer, and ectopic glands were excluded. Data were analyzed by chi-square and Z-test analyses.
RESULTS
Among 810 patients who underwent PTX for pHPT, single abnormal parathyroid glands were unequally distributed among the four eutopic locations (left superior, 15.7%; left inferior, 31.3%; right superior, 15.8%; right inferior, 37.2%; P < 0.01). Abnormal inferior parathyroid glands (68.5%) were significantly more common than abnormal superior glands (31.5%), respectively (P < 0.01). In men, the most common location for single abnormal parathyroid glands was the right inferior position (43.4%, P < 0.01). Overall, there was no significant difference in laterality.
CONCLUSIONS
This large series of patients suggests that single eutopic abnormal parathyroid glands are more likely to be inferior. In men, moreover, if an abnormal parathyroid gland is not localized preoperatively, the right inferior location should be explored first. Nevertheless, successful PTX remains predicated on knowledge of parathyroid anatomy, experience, and judgment of the surgeon.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Follow-Up Studies; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroid Glands; Parathyroidectomy; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 27979480
DOI: 10.1016/j.jss.2016.08.045 -
Clinical Calcium Sep 2005
Review
[Cell proliferation of parathyroid gland in patients with progressive secondary hyperparathyroidism: Vitamin D receptor, calcium sensing receptor, and cell cycle regulation factor].
Topics: Animals; Calcium; Cell Proliferation; Cyclin-Dependent Kinase Inhibitor p21; Disease Progression; Humans; Hyperparathyroidism, Secondary; Hyperplasia; Parathyroid Glands; Parathyroid Hormone; Receptors, Calcitriol; Receptors, Calcium-Sensing; Vitamin D
PubMed: 16279026
DOI: No ID Found -
Clinical Nuclear Medicine Aug 2020We present the first intraoperative detection of a hyperplastic parathyroid gland with a positron emitter F-fluorocholine and handheld probe, with the estimation of the...
We present the first intraoperative detection of a hyperplastic parathyroid gland with a positron emitter F-fluorocholine and handheld probe, with the estimation of the absorbed dose to the surgeon and surgical staff. Intraoperative positron emitter detection enabled the resection of a small parathyroid gland, resulting in normal postoperative values of PTH and serum calcium in a 69-year-old woman. Calculated whole-body dose to the surgical staff and surgeons' fingers is well below the annual limits for exposed workers and the general public. Intraoperative F-FCH detection with handheld probe is a safe and feasible method for localizing small parathyroid glands.
Topics: Aged; Choline; Female; Humans; Hyperparathyroidism, Primary; Monitoring, Intraoperative; Parathyroid Glands; Positron-Emission Tomography; Radiopharmaceuticals
PubMed: 32453078
DOI: 10.1097/RLU.0000000000003106 -
Annals of the New York Academy of... Nov 2011Parathyroid developmental anomalies, which result in hypoparathyroidism, are common and may occur in one in 4,000 live births. Parathyroids, in man, develop from the... (Review)
Review
Parathyroid developmental anomalies, which result in hypoparathyroidism, are common and may occur in one in 4,000 live births. Parathyroids, in man, develop from the endodermal cells of the third and fourth pharyngeal pouches, whereas, in the mouse they develop solely from the endoderm of the third pharyngeal pouches. In addition, neural crest cells that arise from the embryonic mid- and hindbrain also contribute to parathyroid gland development. The molecular signaling pathways that are involved in determining the differentiation of the pharyngeal pouch endoderm into parathyroid cells are being elucidated by studies of patients with hypoparathyroidism and appropriate mouse models. These studies have revealed important roles for a number of transcription factors, which include Tbx1, Gata3, Gcm2, Sox3, Aire1 and members of the homeobox (Hox) and paired box (Pax) families.
Topics: Animals; Disease Models, Animal; Gene Expression Regulation, Developmental; Humans; Hypoparathyroidism; Parathyroid Glands; Signal Transduction; Transcription Factors
PubMed: 22082362
DOI: 10.1111/j.1749-6632.2011.06221.x -
Endocrine Journal 2009
Topics: Adult; Carcinoma, Medullary; Forearm; Humans; Multiple Endocrine Neoplasia Type 2a; Parathyroid Glands; Parathyroidectomy; Risk; Thyroid Neoplasms; Transplantation, Autologous
PubMed: 19461156
DOI: 10.1507/endocrj.k09e-101 -
World Journal of Surgery Oct 2016Major complications of thyroid and parathyroid surgery are recurrent laryngeal nerve injuries and definitive hypoparathyroidism. The use of intra-operative Indocyanine...
Major complications of thyroid and parathyroid surgery are recurrent laryngeal nerve injuries and definitive hypoparathyroidism. The use of intra-operative Indocyanine Green Angiography for confirmation of vascular status of the parathyroid gland is reported here.
Topics: Angiography; Humans; Hyperparathyroidism; Indocyanine Green; Monitoring, Intraoperative; Parathyroid Glands; Parathyroidectomy; Postoperative Complications; Recurrent Laryngeal Nerve Injuries
PubMed: 26944954
DOI: 10.1007/s00268-016-3493-2 -
Surgery Nov 1980In the present work a simplified technique for cryopreservation of parathyroid glands was compared to the generally used technique needing a programmed freezer. Four... (Comparative Study)
Comparative Study
In the present work a simplified technique for cryopreservation of parathyroid glands was compared to the generally used technique needing a programmed freezer. Four groups of rats had total parathyroidectomy. In two of them the glands were cryopreserved and reimplanted 10 days after ablation. The other two groups had, respectively, immediate parathyroid autotransplantation and no autotransplantation. During a follow-up of 60 days, plasma calcium remained low and plasma phosphorus elevated in all aparathyroid rats of the last group. In the group of rats with immediate parathyroid reimplantation, both mean plasma calcium and phosphorus values rapidly returned to the normal values observed before operation. In the rats that had the simplified parathyroid cryopreservation technique, mean plasma phosphorus also returned to the normal range and mean plasma calcium to nearly normal. However, in the group of rats with the classical cryopreservation method, the mean plasma calcium and phosphorus levels remained far from normal in the majority of animals. It was concluded that parathyroid glands of the rat could be successfully autografted after previous freezing using a simplified cryopreservation technique. The results obtained were comparable with, even though not as perfect as, that observed after immediate autotransplantation. If suitable for human parathyroid gland fragments, this technique would allow a more general application of parathyroid tissue cryopreservation.
Topics: Animals; Calcium; Freezing; Male; Organ Preservation; Parathyroid Glands; Phosphorus; Rats; Time Factors; Tissue Preservation; Transplantation, Autologous
PubMed: 7434208
DOI: No ID Found -
The British Journal of Surgery Mar 1996The lateral parathyroid gland of the rabbit was resected and autotransplanted under an ear skin flap. A skin flap at the opposite side was used as control. The success...
The lateral parathyroid gland of the rabbit was resected and autotransplanted under an ear skin flap. A skin flap at the opposite side was used as control. The success of autotransplantation was established by microangiography of the transplant and by measuring plasma concentrations of parathyroid hormone (PTH), calcium and phosphorus. After 4 months the animals were killed and the transplant was studied histologically and by electron microscopy. Fourteen animals were included in the study. There was an increase in PTH derived from the transplanted gland after 4-6 postoperative days. All animals developed hypocalcaemia during the 3 days after transplantation. There were no significant changes in serum phosphorus. Transplantation did not alter the morphology of the distribution of the cells in the transplanted gland, which functioned normally after the fourth postoperative day.
Topics: Animals; Body Weight; Calcium; Female; Male; Parathyroid Glands; Parathyroid Hormone; Phosphorus; Rabbits; Transplantation, Autologous
PubMed: 8665209
DOI: 10.1002/bjs.1800830337 -
Thyroid : Official Journal of the... Oct 2021Accurate assessment of parathyroid gland vascularity is important during thyroidectomy to preserve the function of parathyroid glands and to prevent postoperative...
Accurate assessment of parathyroid gland vascularity is important during thyroidectomy to preserve the function of parathyroid glands and to prevent postoperative hypocalcemia. Laser speckle contrast imaging (LSCI) has been shown to be accurate in detecting differences in parathyroid vascularity. In this surgeon-blinded prognostic study, we evaluate the relationship between intraoperative LSCI measurements and postoperative outcomes of total thyroidectomy patients. Seventy-two thyroidectomy patients were included in this study. After thyroid resection, an LSCI device was used to image all parathyroid glands identified, and a speckle contrast value was calculated for each. An average value was calculated for each patient, and the data were grouped according to whether the patient had normal (16-77 pg/mL) or low levels of parathyroid hormone (PTH) measured on postoperative day 1 (POD1). The aim of this study was to establish a speckle contrast threshold for classifying a parathyroid gland as adequately perfused and to determine how many such glands are required for normal postoperative parathyroid function. A speckle contrast limit of 0.186 separated the normoparathyroid and hypoparathyroid groups with 87.5% sensitivity and 84.4% specificity: 7 of 8 patients with low PTH on POD1 had an average parathyroid speckle contrast above this limit, while 54 of 64 patients with normal postoperative PTH had an average parathyroid speckle contrast below this limit. Taking this value as the threshold for adequate parathyroid perfusion, it was determined that only one vascularized gland was needed for normal postoperative parathyroid function: 64 of 69 patients (92.8%) with at least one vascularized gland (determined by LSCI) had normal postoperative PTH, while all 3 patients (100%) with no vascularized glands had low postoperative PTH. Overall, the rates of temporary and permanent hypoparathyroidism in this study were 8.3% and 1.4%, respectively. LSCI is a promising technique for assessing parathyroid gland vascularity. It has the potential to help reduce the incidence of hypocalcemia after thyroidectomy by providing surgeons with additional information during surgery to aid in the preservation of parathyroid function.
Topics: Adult; Female; Humans; Hypocalcemia; Intraoperative Period; Laser Speckle Contrast Imaging; Male; Middle Aged; Organ Sparing Treatments; Parathyroid Glands; Postoperative Complications; Prognosis; Surgery, Computer-Assisted; Thyroidectomy
PubMed: 34078120
DOI: 10.1089/thy.2021.0093 -
Surgery Jan 2019Difficulty in identifying the parathyroid gland during neck operations can lead to accidental parathyroid gland excisions and postsurgical hypocalcemia. A clinical...
BACKGROUND
Difficulty in identifying the parathyroid gland during neck operations can lead to accidental parathyroid gland excisions and postsurgical hypocalcemia. A clinical prototype called as PTeye was developed to guide parathyroid gland identification using a fiber-optic probe that detects near-infrared autofluorescence from parathyroid glands as operating room lights remain on. An Overlay Tissue Imaging System was designed concurrently to detect near-infrared autofluorescence and project visible light precisely onto parathyroid gland location.
METHODS
The PTeye and the Overlay Tissue Imaging System were tested in 20 and 15 patients, respectively, and a modified near-infrared imaging system was investigated in 6 patients. All 41 patients underwent thyroidectomy or parathyroidectomy. System accuracy was ascertained with surgeon's visual confirmation for in situ parathyroid glands and histology for excised parathyroid glands.
RESULTS
There was no observable difference between near-infrared autofluorescence of healthy and diseased parathyroid glands. The PTeye identified 98% of the parathyroid gland, whereas the near-infrared imaging system and the Overlay Tissue Imaging System identified 100% and 97% of the parathyroid glands, respectively.
CONCLUSION
The PTeye can guide in real-time parathyroid gland identification even with ambient operating room lights. The near-infrared imaging system performs parathyroid gland imaging with high sensitivity, whereas the Overlay Tissue Imaging System enhances parathyroid gland visualization directly within the surgical field without requiring display monitors. These label-free technologies can be valuable adjuncts for identifying parathyroid glands intraoperatively.
Topics: Adult; Aged; Female; Fiber Optic Technology; Humans; Intraoperative Complications; Male; Middle Aged; Optical Imaging; Parathyroid Glands; Parathyroidectomy; Thyroidectomy; Young Adult
PubMed: 30442424
DOI: 10.1016/j.surg.2018.04.079