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Clinical and Experimental Nephrology May 2023Parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) each play a central role in the pathogenesis of chronic kidney disease-mineral and bone disorder... (Review)
Review
Parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23) each play a central role in the pathogenesis of chronic kidney disease-mineral and bone disorder (CKD-MBD). Both hormones increase as kidney function declines, presumably as a response to maintain normal phosphate balance, but when patients reach kidney failure, PTH and FGF23 fail to exert their phosphaturic effects, leading to hyperphosphatemia and further elevations in PTH and FGF23. In patients with kidney failure, the major target organ for PTH is the bone, but elevated PTH is also associated with mortality presumably through skeletal and nonskeletal mechanisms. Indeed, accumulated evidence suggests improved survival with PTH-lowering therapies, and a more recent study comparing parathyroidectomy and calcimimetic treatment further suggests a notion of "the lower, the better" for PTH control. Emerging data suggest that the link between SHPT and mortality could in part be explained by the action of PTH to induce adipose tissue browning and wasting. In the absence of a functioning kidney, the classical target organ for FGF23 is the parathyroid gland, but FGF23 loses its hormonal effect to suppress PTH secretion owing to the depressed expression of parathyroid Klotho. In this setting, experimental data suggest that FGF23 exerts adverse nontarget effects, but it remains to be confirmed whether FGF23 directly contributes to multiple organ injury in patients with kidney failure and whether targeting FGF23 can improve patient outcomes. Further efforts should be made to determine whether intensive control of SHPT improves clinical outcomes and whether nephrologists should aim at controlling FGF23 levels just as with PTH levels.
Topics: Humans; Bone and Bones; Fibroblast Growth Factors; Parathyroid Glands; Parathyroid Hormone; Renal Insufficiency
PubMed: 36977891
DOI: 10.1007/s10157-023-02336-y -
International Journal of Molecular... Apr 2024Transient receptor potential canonical sub-family channel 3 (TRPC3) is considered to play a critical role in calcium homeostasis. However, there are no established...
Transient receptor potential canonical sub-family channel 3 (TRPC3) is considered to play a critical role in calcium homeostasis. However, there are no established findings in this respect with regard to TRPC6. Although the parathyroid gland is a crucial organ in calcium household regulation, little is known about the protein distribution of TRPC channels-especially TRPC3 and TRPC6-in this organ. Our aim was therefore to investigate the protein expression profile of TRPC3 and TRPC6 in healthy and diseased human parathyroid glands. Surgery samples from patients with healthy parathyroid glands and from patients suffering from primary hyperparathyroidism (pHPT) were investigated by immunohistochemistry using knockout-validated antibodies against TRPC3 and TRPC6. A software-based analysis similar to an H-score was performed. For the first time, to our knowledge, TRPC3 and TRPC6 protein expression is described here in the parathyroid glands. It is found in both chief and oxyphilic cells. Furthermore, the TRPC3 staining score in diseased tissue (pHPT) was statistically significantly lower than that in healthy tissue. In conclusion, TRPC3 and TRPC6 proteins are expressed in the human parathyroid gland. Furthermore, there is strong evidence indicating that TRPC3 plays a role in pHPT and subsequently in parathyroid hormone secretion regulation. These findings ultimately require further research in order to not only confirm our results but also to further investigate the relevance of these channels and, in particular, that of TRPC3 in the aforementioned physiological functions and pathophysiological conditions.
Topics: Humans; TRPC Cation Channels; Hyperparathyroidism, Primary; Parathyroid Glands; Female; Male; TRPC6 Cation Channel; Down-Regulation; Middle Aged; Aged; Adult; Immunohistochemistry; Parathyroid Hormone
PubMed: 38673977
DOI: 10.3390/ijms25084392 -
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 -
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 -
The American Journal of Pathology Nov 1986The authors studied the parathyroid glands from 100 previously healthy subjects who died suddenly and were admitted to the Dade County Medical Examiner's (ME) morgue and...
The authors studied the parathyroid glands from 100 previously healthy subjects who died suddenly and were admitted to the Dade County Medical Examiner's (ME) morgue and from 66 inpatients who died at Jackson Memorial Hospital (JMH). Parathyroid glands in patients with diseases (JMH series) were heavier than those in healthy persons (ME series), and both groups of glands were significantly heavier than those previously reported. Mean glandular weight in white subjects was 42.6 +/- 20.3 mg, with a range of 22-103 mg. The 95% upper limit of gland weight for healthy white subjects was 73.1 mg and for black subjects, 91.6 mg. The size and weight exhibited a skewed distribution. Gland weight varied with age, increasing to a maximum in the 41-60 year old age group in all subsets except white women, in whom it continued to increase till after age 70. There was slight correlation (r2 = 0.15) of gland weight with body weight within series and race groups; parenchymal content of the glands was not constant but correlated positively with glandular weight. Glands from both series had a comparable fat content. Fat was unevenly distributed throughout the gland, and its amount was highly variable, ranging between 0 and 90%, with a mean of 26% for white subjects and 24% for black subjects in both series. Therefore, percentage fat may not be used as an index of hyperplasia. Healthy back subjects had heavier glands than healthy white subjects, unaccounted for by differences in body weights; this difference was not statistically significant in subjects with disease. Within the black race, glands were not significantly heavier in disease than in health, and in the few cases with serum calcium determinations, the gland weight did not vary inversely with serum calcium levels as in white subjects, suggesting a basic difference in parathyroid calcium metabolism between the two races.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Autopsy; Black People; Body Weight; Child; Female; Humans; Male; Middle Aged; Organ Size; Parathyroid Glands; Sex Factors; White People
PubMed: 3789088
DOI: No ID Found -
Frontiers in Endocrinology 2023
Topics: Humans; Parathyroid Diseases; Parathyroid Glands
PubMed: 38027097
DOI: 10.3389/fendo.2023.1323778 -
Surgical Oncology Clinics of North... Jan 2008A technique of thyroidectomy that facilitates resection of the thyroid, preserves the parathyroid glands with their blood supply, and preserves the recurrent and the... (Review)
Review
A technique of thyroidectomy that facilitates resection of the thyroid, preserves the parathyroid glands with their blood supply, and preserves the recurrent and the superior laryngeal nerves is described. This technique provides a simple and versatile means of complete extracapsular thyroidectomy for lesions of the thyroid gland and minimizes postoperative complications.
Topics: Goiter; Humans; Parathyroid Glands; Postoperative Care; Risk Factors; Thyroid Neoplasms; Thyroidectomy
PubMed: 18177802
DOI: 10.1016/j.soc.2007.10.014 -
Frontiers in Endocrinology 2021We aim to assess the accuracy of near infrared autofluorescence in identifying parathyroid gland during thyroid and parathyroid surgery. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We aim to assess the accuracy of near infrared autofluorescence in identifying parathyroid gland during thyroid and parathyroid surgery.
METHOD
A systematic literature search was conducted by using PubMed, Embase, and the Cochrane Library electronic databases for studies that were published up to February 2021. The reference lists of the retrieved articles were also reviewed. Two authors independently assessed the methodological quality and extracted the data. A random-effects model was used to calculate the combined variable. Publication bias in these studies was evaluated with the Deeks' funnel plots.
RESULT
A total of 24 studies involving 2,062 patients and 6,680 specimens were included for the meta-analysis. The overall combined sensitivity and specificity, and the area under curve of near infrared autofluorescence were 0.96, 0.96, and 0.99, respectively. Significant heterogeneities were presented (Sen: I = 87.97%, Spe: I = 65.38%). In the subgroup of thyroid surgery, the combined sensitivity and specificity, and the area under curve of near infrared autofluorescence was 0.98, 0.99, and 0.99, respectively, and the heterogeneities were moderate (Sen: I = 59.71%, Spe: I = 67.65%).
CONCLUSION
Near infrared autofluorescence is an excellent indicator for identifying parathyroid gland during thyroid and parathyroid surgery.
Topics: Animals; Humans; Optical Imaging; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy; Spectroscopy, Near-Infrared; Thyroid Neoplasms; Thyroidectomy
PubMed: 34234746
DOI: 10.3389/fendo.2021.701253 -
Chirurgia (Bucharest, Romania : 1990) Jun 2023The main postoperative complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. Methylene blue, which is a drug and dye, is safe...
The main postoperative complications of thyroidectomy are hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. Methylene blue, which is a drug and dye, is safe and easy to get, and we can use it to avoid complications during thyroidectomy. Objectives: We aim to assess that we can spray Methylene blue to allow the identification of important structures intraoperative which are the parathyroid gland and recurrent laryngeal nerve. Also, to evaluate that this technique is safe, effective, technically feasible, and less dangerous than other techniques. Our study is a prospective cohort study of patients, patients who presented with simple nodular goiter, solitary thyroid nodule, controlled toxic goiter, and failed medical treatment with the indication for thyroidectomy, suspected malignancy, and retrosternal goiters at El-Demerdash Hospital from the period of August 2021 to August 2022. In the specified study period of 1 year from 1/8/2021 to 31/7/2022. Sixty patients underwent thyroidectomy 54 underwent total while 6 only underwent hemithyroidectomy. The time taken to wash out the dye over the thyroid gland was 15 to 25 minutes, the parathyroid gland was 4 to 7 minutes and the recurrent laryngeal nerve (RLN) was almost 0 to 1 minute and this indicated that the RLN almost did not take the dye. In the controlled group, two patients had symptoms and signs of hypocalcemia only one of them had signs of tetany, 8 patients had laboratory hypocalcemia, two patients suffered from a change of voice and another two patients suffered difficulty breathing one of which needed temporary tracheostomy while in the interventional group, only one patient had symptoms and signs of hypocalcemia no one had signs of tetany, two patients had laboratory hypocalcemia, one patient suffered from the change of voice and another two patients suffered the difficulty of breathing but no one needed a tracheostomy tube. It is safe, useful, and suitable to use Methylene blue spraying to keep the parathyroid gland and RLN during thyroidectomy, which led us to reduce the percentage of incidence of postoperative complications. Also, it helped us to find the parathyroid gland and RLN during the surgery, despite some surgeons seeing that searching for the parathyroid and RLN can lead to harmful effects and increase the incidence of injury.
Topics: Humans; Parathyroid Glands; Thyroidectomy; Methylene Blue; Recurrent Laryngeal Nerve; Tetany; Hypocalcemia; Prospective Studies; Treatment Outcome
PubMed: 37480355
DOI: 10.21614/chirurgia.2023.v.118.i.3.p.291 -
Canadian Association of Radiologists... Aug 2013Accurate preoperative localization is the key to successful parathyroid surgery in the era of minimally invasive parathyroid surgery. This article presents and discusses... (Review)
Review
Accurate preoperative localization is the key to successful parathyroid surgery in the era of minimally invasive parathyroid surgery. This article presents and discusses the embryologic basis of parathyroid gland and ectopic location and different imaging modalities helpful in diagnosing and localizing parathyroid adenomas and/or hyperplasia. We also aim to review the current surgical concepts in treatment of parathyroid adenomas and/or hyperplasia, the utility of 4-dimensional computed tomography for accurate preoperative localization of hyperfunctioning parathyroid glands, imaging classification of adenomas and/or hyperplasia, and, finally, present some of the limitations of 4-dimensional computed tomography.
Topics: Adenoma; Adult; Aged; Contrast Media; Female; Four-Dimensional Computed Tomography; Humans; Hyperplasia; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Preoperative Care; Radiographic Image Enhancement; Reproducibility of Results; Triiodobenzoic Acids
PubMed: 23260861
DOI: 10.1016/j.carj.2012.03.002