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Lelli G, Micalizzi A, Gurrado A, Bononi M, Iossa A, De Angelis F, Di Meo D, Fassari A, Testini M, Cavallaro G. 5-year Follow-up of Reimplanted Parathyroid Glands in Forearm Subcutaneous Tissue During Thyroidectomy. A Confirmation of Graft Vitality in a Large Series of Patients. Am Surg 2024:31348241244631. [PMID: 38557257 DOI: 10.1177/00031348241244631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION The aim of this study is to assess the outcomes of parathyroid gland reimplantation with PR-FaST technique in patients undergoing thyroid surgery, focusing on graft functionality over a 5-year follow-up period. MATERIALS AND METHODS We analyzed data from 131 patients who underwent parathyroid reimplantation using the PR-FaST technique during thyroid surgery due to inadvertent parathyroid removal or evident vascular damage. Postoperative evaluations included serum calcium (Ca), magnesium (Mg), and phosphorus (P) analyses on the 1st and 2nd postoperative days, at 10 days, and at 1, 3, 6 months, 1 year, and 5 years of follow-up. Additionally, the mean values of serum intact parathyroid hormone (iPTH) concentration were measured from blood samples collected from both the reimplanted arm (iPTH RA) and non-reimplanted arm (iPTH NRA) within the same period. RESULTS Among 131 patients, at 10 days post-surgery, only 46 patients (35.1%) out of 131 exhibited graft viability (iPTH ratio >1.5). This percentage increased to 72.8% (94 patients) after 1 month and further to 87.8% (108 patients) after 3 months post-surgery. At 1 year, 84.7% of patients showed good graft functionality. After 5 years, the percentage remained stable, with graft viability observed in 81.3% of patients. Only 91 of the initial 131 patients completed follow-up up to 5 years, with a dropout rate of 30.5 %. CONCLUSIONS Parathyroid reimplantation using the PR-FaST technique is a viable option for patients undergoing thyroidectomy and has been shown to be a reproducible and effective technique in most patients, with sustained graft functionality and parathyroid hormone production over a 5-year follow-up period.
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Affiliation(s)
- Giulio Lelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Alessandra Micalizzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Angela Gurrado
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, Bari, Italy
| | - Marco Bononi
- Department of Surgery, Sapienza University, Rome, Italy
| | - Angelo Iossa
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Francesco De Angelis
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Diletta Di Meo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Alessia Fassari
- General Surgery Unit, Luxembourg Hospital Center, Luxembourg, Europe
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, Bari, Italy
| | - Giuseppe Cavallaro
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
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Dong Z, Liu W, Peng Y, Zhan X, Su Y, Diao C, Cheng R. Single inferior parathyroid autotransplantation during total thyroidectomy with bilateral central lymph node dissection for papillary thyroid carcinoma: a retrospective cohort study. World J Surg Oncol 2023; 21:102. [PMID: 36959661 PMCID: PMC10035247 DOI: 10.1186/s12957-023-02886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/09/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Management of the inferior parathyroid gland using total thyroidectomy (TT) with central lymph node dissection (CLND) is still controversial. Therefore, we evaluated the safety and effectiveness of single inferior parathyroid autotransplantation. METHODS The clinical data of patients with papillary thyroid carcinoma (PTC) who underwent TT with bilateral CLND from January 2018 to December 2020 were collected. Quality of life (QoL) was assessed using the Chinese version of the EORTC QLQ-C30 and THYCA-QOL. The patients were divided into an autotransplantation group and a preservation group according to whether a single inferior parathyroid gland was transplanted. The incidence of permanent hypoparathyroidism, the number of resected central lymph nodes (CLNs), the rate of recurrence reoperation, the rate of radioactive iodine (RAI) treatment, and the QoL score were compared between the two groups. RESULTS A total of 296 patients were included in the study; there were 99 patients in the autotransplantation group and 197 in the preservation group. The incidence of permanent hypoparathyroidism was 3.0% (3/99) and 4.6% (9/197) in the autotransplantation and preservation groups, respectively (P = 0.532). The median number of resected CLNs was 12 (8-17) and 10 (6-14) in the autotransplantation and preservation groups, respectively (P = 0.015). No reoperations were performed for patients with CLN recurrence, and the rates of lateral lymph node (LLN) recurrence reoperation were 2.0% (2/99) and 3.6% (7/197) in the autotransplantation and preservation groups, respectively (P = 0.473). The RAI treatment rates were 12.1% (12/99) and 22.3% (44/197) in the autotransplantation and preservation groups, respectively (P = 0.034). A total of 276 questionnaires were recovered, including 84 in the autotransplantation group and 192 in the preservation group. The QoL of the two groups of patients is similar (P > 0.05). CONCLUSION Single inferior parathyroid autotransplantation during thyroidectomy can be used to prevent permanent hypoparathyroidism and can enable more extensive CLND.
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Affiliation(s)
- Zhizhong Dong
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wen Liu
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ying Peng
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiangxiang Zhan
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanjun Su
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chang Diao
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruochuan Cheng
- Department of Thyroid Surgery, Clinical Research Center for Thyroid Diseases of Yunnan Province, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
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Li J, Tang Q, Yang X, He G, Lin C, Zhang D. Autologous parathyroid gland left brachioradialis transplantation: A single-center study and long-term follow-up. Asian J Surg 2022; 46:1550-1555. [PMID: 36085124 DOI: 10.1016/j.asjsur.2022.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/29/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022] Open
Abstract
Parathyroid gland transplantation into the sternocleidomastoid muscle is effective, but it is not possible to confirm transplant survival with this method. In this study, we evaluated parathyroid autotransplantation into the brachioradialis muscle and its survival rate. OBJECTIVES To evaluate autologous parathyroid gland left forearm brachioradial muscle transplantation and its survival rate. SUMMARY BACKGROUND DATA The most commonly used transplantation site is the sternocleidomastoid muscle, but transplant survival cannot be confirmed using this method. Autologous parathyroid gland left forearm brachioradial muscle transplantation solves this problem, and we evaluate the transplant survival using this method. METHODS We followed-up patients who underwent thyroidectomy and autologous parathyroid left forearm brachioradial muscle transplantation in our center from September 2013 to January 2018. The last follow-up date was January 2021; all enrolled patients underwent at least 3 years of follow-up. We calculated the transplant survival rate at several time points. RESULTS We evaluated 238 transplanted cases, for which the long-term survival rate was 85.7% (204/238), and the short-term survival rate was 86.1% (205/238). Sixty-five cases had two parathyroid glands transplanted into the left forearm brachioradialis muscle. The long-term survival rate was 92.3% (60/65), and the short-term survival rate was 95.4% (62/65). CONCLUSIONS Autologous parathyroid gland left brachioradialis transplantation is a reliable, measurable method with good survival rate, and we recommend this method for consideration for transplanting parathyroid glands in thyroidectomy.
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Affiliation(s)
- Jianbo Li
- Department of Head and Neck Surgery, Institute of Micro-Invasive Surgery of Zhejiang University, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, PR China
| | - Qinghu Tang
- Department of Surgery, Linghu People's Hospital, Nanxun District, Huzhou City, No. 6666, Fengming Road, PR China
| | - Xiaozhen Yang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Qingchun East Road No. 3, Hangzhou, PR China
| | - Gaofei He
- Department of Head and Neck Surgery, Institute of Micro-Invasive Surgery of Zhejiang University, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, PR China
| | - Chengping Lin
- Second People's Hospital of Linhai, Zhejiang, PR China.
| | - Deguang Zhang
- Department of Head and Neck Surgery, Institute of Micro-Invasive Surgery of Zhejiang University, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, Hangzhou, PR China.
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Zhang Q, Qu KP, Wang ZS, Gao JW, Zhang YP, Cao WJ. Clinical application of parathyroid autotransplantation in endoscopic radical resection of thyroid carcinoma. Front Oncol 2022; 12:942488. [PMID: 35992841 PMCID: PMC9386417 DOI: 10.3389/fonc.2022.942488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/13/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose This study aimed to examine the effect of selective inferior parathyroid gland autotransplantation on central lymph node dissection(CLND) and incidence of postoperative hypoparathyroidism in patients undergoing endoscopic radical resection of thyroid carcinoma. Methods The data of 310 patients undergoing endoscopic radical resection of thyroid carcinoma will be retrospectively analyzed. The patients will be divided into the experimental group and the control group according to whether they combined with parathyroid autotransplantation. Statistics of the incidence rate of postoperative hypoparathyroidism, the concentration of PTH and Calcium in the systemic circulation at different time points in the two groups, the concentration of PTH in the cubital fossa vein in the transplantation region in the experimental group, and the number of central lymph nodes and positive lymph nodes dissection will be carried out. Results The incidence rate of temporary and permanent hypoparathyroidism in the experimental group was 33.75% and 0.625%, respectively, and in the control group was 22% and 5%, respectively; its difference was statistically significant (X2 = 10.255, P=0.006). Parathyroid autotransplantation increased incidence of transient hypoparathyroidism (OR, 1.806; Cl, 1.088-2.998; P=0.022), and lower incidence of permanent hypoparathyroidism (OR, 0.112; Cl, 0.014-0.904; P=0.040). The diameters of thyroid cancer nodules was not associated with the occurrence of transient hypoparathyroidism (OR, 0.769; Cl, 0.467-1.265; P=0.301) or permanent hypoparathyroidism (OR, 1.434; Cl, 0.316-6.515; P=0.641). Comparison of systemic circulation PTH, between the two groups showed that the PTH of patients in the experimental group was higher than that in the control group from 1 week to 12 months after the operation, and the difference was statistically significant (P<0.05). In the experimental group, from 1 week to 12 months after surgery, PTH concentrations was significantly higher in the cubital fossa of the transplantation side than in the contralateral side, and the differences were statistically significant (P<0.05). The mean number of central lymph node dissected per patient was significantly higher in the experimental group (7.94 ± 3.03 vs. 6.99 ± 2.86; P <0.05); The mean number of positive nodes per patient was significantly higher in the experimental group (3.16 ± 1.86 vs. 2.53 ± 1.59; P <0.05). Conclusions In endoscopic radical resection of thyroid carcinoma, parathyroid autotransplantation is more beneficial to postoperative parathyroid glands function recovery, effectively preventing postoperative permanent hypoparathyroidism and realizing more thorough CLND.
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Affiliation(s)
- Qi Zhang
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Kun-Peng Qu
- Department of General Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
- *Correspondence: Kun-Peng Qu,
| | - Ze-Sheng Wang
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jing-Wei Gao
- The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yu-Peng Zhang
- Department of General Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
| | - Wei-Jia Cao
- Department of General Surgery, Gansu Provincial People’s Hospital, Lanzhou, China
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Tarallo M, Crocetti D, Gurrado A, Iorio O, Iossa A, Caruso D, Bononi M, Stabilini C, Bracale U, Chiappini A, Testini M, Avenia N, Polistena A, Cavallaro G. Achieving the learning curve in total thyroidectomy: a prospective evaluation on resident's training by CUSUM and KPSS analysis. Ann R Coll Surg Engl 2022; 104:414-420. [PMID: 35175830 PMCID: PMC9157995 DOI: 10.1308/rcsann.2021.0318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Total thyroidectomy (TT) is one of the most common procedures among general and endocrine surgeons worldwide. The conventional approach by neck incision is still the most frequently used, despite the growth of mini-invasive approaches. Controversies exist about the optimal learning curve for resident surgeons approaching this procedure. The aim of this study was to compare TT performed by experienced surgeons and residents in two academic hospitals, to define the correct shape of the specific learning curve. METHODS Between January 2016 and December 2018 patients undergoing TT in two academic departments were prospectively enrolled. In each department patients were divided into four groups: a reference group (A), consisting of 50 consecutive patients operated on by a senior surgeon, and three other groups (B, C, D) of 50 patients each where thyroidectomy was carried out by three different general surgery residents in their last 3 years of residency, respectively. Data were analysed by CUSUM and KPSS tests in order to compare operative time (OT) and its stabilisation during the learning curve. RESULTS Data from CUSUM test reported that residents could perform TT with OT similar to the senior surgeon after approximately 25-30 procedures, while the KPSS test showed that residents became more stable after 30 procedures, with no increase in perioperative complications. CONCLUSIONS This prospective study shows how a specific training in thyroid surgery can be reliable thanks to experienced tutors, and confirmed that the effect of dedicated and programmed training may result in positive outcomes for patients requiring thyroidectomy.
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Affiliation(s)
| | | | | | - O Iorio
- A. Spaziani Hospital, Frosinone (FR), Italy
| | - A Iossa
- Sapienza University, Rome, Italy
| | - D Caruso
- Sapienza University, Rome, Italy
| | - M Bononi
- Sapienza University, Rome, Italy
| | | | - U Bracale
- Federico II University Hospital, Naples, Italy
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Green K, Hintze J, O'Neill JP. Surgical aspects and controversies in the management of medullary thyroid cancer. Ir J Med Sci 2022; 191:2461-2466. [PMID: 35064534 DOI: 10.1007/s11845-021-02886-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/07/2021] [Indexed: 01/02/2023]
Abstract
Medullary thyroid cancer (MTC) accounts for only 4% of thyroid carcinomas but 15% of thyroid cancer deaths. MTC is a tumour of the calcitonin secreting parafollicular C cells in the thyroid which can occur sporadically or be hereditary in multiple endocrine neoplasias type 2 syndromes due to germline RET mutations. Sporadic forms of MTC can also be caused by mutations in the RET protooncogene. MTC commonly presents in a late stage, with 70% of patients presenting with local nodal metastasis. Currently, the only curative treatment for MTC is surgical removal. The aim of this paper is to describe the current guidelines and progressions of the surgical management of MTC and to highlight up-and-coming chemotherapies. A database literature review was completed utilizing PubMed to cumulate the extant literature, screening for most recent guidelines and publications regarding the management of MTC. Current guidelines were described by the American Thyroid Association in 2015. Controversial publications continue to present supporting evidence for varying degrees of thyroidectomy and neck dissections. Recently, researchers have been exploring non-surgical options including external beam radiotherapy and multikinase inhibitors such as vandetanib and cabozantinib for the treatment of MTC. Surgical management of MTC remains controversial and varies significantly dependent on the extent of disease. Chemotherapeutic options have undetermined effects on survival to date.
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Affiliation(s)
| | - Justin Hintze
- Department of Otolaryngology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James Paul O'Neill
- Department of Otolaryngology, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
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Hypoparathyroidism: State of the Art on Cell and Tissue Therapies. Int J Mol Sci 2021; 22:ijms221910272. [PMID: 34638612 PMCID: PMC8508771 DOI: 10.3390/ijms221910272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022] Open
Abstract
Hypoparathyroidism is an endocrine disorder characterized by low serum calcium levels, high serum phosphorus levels, and by inappropriate or absent secretion of the parathyroid hormone (PTH). The most common therapeutic strategy to treat this condition is hormone replacement therapy with calcium and vitamin D but, unfortunately, in the long term this treatment may not be sufficient to compensate for the loss of endocrine function. Glandular autotransplantation is considered the most effective technique in place of replacement therapy. Although it leads to excellent results in most cases, autotransplantation is not always possible. Allograft is a good way to treat patients who have not been able to undergo autograft, but this technique has limited success due to side effects related to tissue rejection. This therapy is supported by systemic immunosuppression, which leads to the onset of serious side effects in patients, with a risk of endocrine toxicity. Today, research on endocrine disorders is focused on discovering alternative graft therapies that can allow optimal results with the fewest possible side effects. In this review, we will make an update on the current state of the art about the cell and tissue therapy as treatment for hypoparathyroidism, to identify which type of therapeutic strategy could be valid for a future clinical use.
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Kim E, Ramonell KM, Mayfield N, Lindeman B. Parathyroid allotransplantation for the treatment of permanent hypoparathyroidism: A systematic review. Am J Surg 2021; 223:652-661. [PMID: 34304848 DOI: 10.1016/j.amjsurg.2021.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/22/2021] [Accepted: 07/18/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hypoparathyroidism is the most common complication of bilateral operations in the central neck. No formal guidelines exist for the management of permanent hypoparathyroidism. Current treatment involving medical supplementation increases resource utilization and patient morbidity while decreasing quality of life. Parathyroid allotransplant (PA) offers a promising therapy; however, the optimal technique and role of immunosuppression (IS) in PA remain unclear. METHODS We performed a systematic search of the Embase, MEDLINE, and Cochrane Library databases to identify studies investigating PA for treatment of hypoparathyroidism. RESULTS A total of 24 studies including 186 individual allograft transplants in 146 patients were identified. Pooled graft survival for allotransplants in transplant-naïve vs prior transplant recipients was 29.9% and 80%, respectively. CONCLUSIONS PA using normocellular, fresh parathyroid donor tissue that is ABO-compatible, with induction and, at minimum, short-term maintenance IS presents a potentially safe and effective therapeutic option for permanent hypoparathyroidism in patients tolerating IS.
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Affiliation(s)
- Eric Kim
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
| | - Kimberly M Ramonell
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
| | - Nicolas Mayfield
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
| | - Brenessa Lindeman
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
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Qiu Y, Xing Z, Qian Y, Fei Y, Luo Y, Su A. Selective Parathyroid Autotransplantation During Total Thyroidectomy for Papillary Thyroid Carcinoma: A Cohort Study. Front Surg 2021; 8:683041. [PMID: 34262932 PMCID: PMC8274712 DOI: 10.3389/fsurg.2021.683041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/07/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose: The relationship between the selective parathyroid gland (PG) autotransplantation and hypoparathyroidism is still not completely clear. The aim was to ascertain whether the number of autotransplanted PGs affected the incidence of hypoparathyroidism and recovery of parathyroid function in the long-term for patients with papillary thyroid carcinoma (PTC). Methods: A retrospective cohort study included all patients with PTC who had underwent primary total thyroidectomy with central neck dissection between January 2013 and December 2017. The patients were divided into three groups (0, 1, and 2 PGs autotransplanted, respectively). Results: Of the 2,477 patients, 634 (25.6%) received no PG autotransplantation, 1,078 (43.5%) and 765 (30.9%) were autotransplanted 1 and 2 PGs, respectively, and the incidence of permanent hypoparathyroidism (>1 year) was 1.7%, 0.7%, and 0.4% (P = 0.0228). Both 1 or 2 PGs autotransplanted increased the incidence of transient biochemical hypoparathyroidism (odds ratio [OR], 1.567; 95% confidence interval [CI], 1.258-1.953; P < 0.0001; OR, 2.983; 95% CI, 2.336-3.810; P < 0.0001, respectively) but reduced the incidence of permanent hypoparathyroidism (OR, 0.373; 95% CI, 0.145-0.958; P = 0.0404; OR, 0.144; 95% CI, 0.037-0.560; P = 0.0052, respectively). Both 1 or 2 PGs autotransplanted did not independently influence the occurrence of hypocalcemia symptoms. Conclusion: Selective parathyroid autotransplantation is less likely to lead to post-operative symptomatic hypocalcemia, although it could lead to a transient decrease in parathyroid hormone. However, in the long run, it is still an effective strategy to preserve parathyroid function.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China.,Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuanfan Qian
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Fei
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Anping Su
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
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Zheng J, Cai S, Song H, Wang Y, Han X, Han G, Wu H, Gao Z. Measurement of serum intact parathyroid hormone concentration 1 day after total thyroidectomy to assess risk of permanent hypoparathyroidism. J Int Med Res 2021; 48:300060520927199. [PMID: 32527180 PMCID: PMC7294503 DOI: 10.1177/0300060520927199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE This study was performed to assess the clinical value of measuring the intact parathyroid hormone (iPTH) concentration 1 day after total thyroidectomy to estimate the occurrence of permanent hypoparathyroidism (pHPP). METHODS Data of 546 patients who underwent total thyroidectomy from February 2008 to December 2018 were retrospectively analyzed. Calcium and iPTH concentrations were collected preoperatively and at 1 day and 6 months postoperatively. Logistic regression was used to analyze the correlation between clinical indexes and postoperative pHPP. RESULTS Of the 546 patients, 22 (4.03%) developed pHPP. Multivariate analysis showed that the iPTH and serum calcium concentrations measured 1 day after surgery were independent predictors of the risk of pHPP. An iPTH concentration of 5.51 pg/mL measured 1 day postoperatively was used as the cut-off value, and the area under the curve was 0.956. The risk of pHPP was identified with a sensitivity of 100%, specificity of 85.1%, positive predictive value of 22%, and negative predictive value of 100%. CONCLUSIONS The iPTH concentration measured 1 day after total thyroidectomy is closely related to the occurrence of pHPP postoperatively and is an independent predictive risk factor. The postoperative iPTH concentration can be helpful in identifying patients at risk for developing pHPP.
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Affiliation(s)
- Jianwei Zheng
- Department of General Surgery, Beijing Chaoyang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Shuyan Cai
- Department of General Surgery, Beijing Chaoyang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Huimin Song
- Department of General Surgery, Beijing Chaoyang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Yunlei Wang
- Department of General Surgery, Beijing Chaoyang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Xiaofeng Han
- Department of General Surgery, Beijing Chaoyang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Gang Han
- Department of General Surgery, Beijing Chaoyang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Haoliang Wu
- Department of General Surgery, Beijing Chaoyang Hospital Affiliated with Capital Medical University, Beijing, China
| | - Zhigang Gao
- Department of General Surgery, Beijing Chaoyang Hospital Affiliated with Capital Medical University, Beijing, China
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Qiu Y, Xing Z, Xiang Q, Yang Q, Su A, Luo Y. Duration of Parathyroid Function Recovery in Patients With Protracted Hypoparathyroidism After Total Thyroidectomy for Papillary Thyroid Carcinoma. Front Endocrinol (Lausanne) 2021; 12:665190. [PMID: 33953701 PMCID: PMC8090861 DOI: 10.3389/fendo.2021.665190] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/01/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of the present study is to investigate the time to recovery of parathyroid function in patients with protracted hypoparathyroidism at 1 month after total thyroidectomy of papillary thyroid carcinoma. MATERIALS AND METHODS Adult patients who underwent total thyroidectomy for papillary thyroid cancer were included. Cases of long-term hypoparathyroidism were studied for recovery of parathyroid function during the follow-up. The duration of recovery and associated variables were recorded. RESULTS Out of the 964 patients, 128 (13.28%) developed protracted hypoparathyroidism and of these, 23 (2.39%) developed permanent hypoparathyroidism and 105 (10.89%) recovered: 86 (8.92%) before 6 months, 11 (1.14%) within 6 and 12 months and 8 (0.83%) after 1 year follow-up. Variables significantly associated with the time to parathyroid function recovery were number of autotransplanted parathyroid glands (HR, 1.399; 95% CI, 1.060 - 1.846; P = 0.018), serum calcium concentration >2.07 mmol/L (Hazard ratio [HR], 1.628; 95% confidence interval [CI], 1.009 - 2.628; P = 0.046) and PTH level > 1.2 pmol/L (HR, 1.702; 95% CI, 1.083 - 2.628; P = 0.021) at 1 month postoperatively. CONCLUSION Permanent hypoparathyroidism should not be diagnosed easily by time, since up to one-fifth of the patients will experience recovery after a period of 6 months and a few patients even beyond one year. The number of autotransplanted parathyroid glands is positively associated with the time to parathyroid function recovery.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhichao Xing
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiao Xiang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Qianru Yang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Anping Su
- Center of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yan Luo, ; Anping Su,
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yan Luo, ; Anping Su,
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Wang B, Zhu CR, Liu H, Yao XM, Wu J. The inferior parathyroid glands preserved in site recover faster than the superior parathyroid glands preserved in site after thyroid surgery for carcinoma. Medicine (Baltimore) 2020; 99:e20886. [PMID: 32664081 PMCID: PMC7360264 DOI: 10.1097/md.0000000000020886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Due to the great difficulty in being preserved in site for the variable positions, the inferior parathyroid glands were advised to being routinely autotransplanted to prevent permanent hypoparathyroidism. The aim of this study was to compare the performance in the function of the superior parathyroid glands preserved in site with that of the inferior parathyroid glands preserved in site.We conducted a retrospective study including patients who underwent thyroid surgery for papillary thyroid carcinoma at our department between January 2014 and June 2018. According to the number and original position of the autoplastic parathyroid gland(s), patients were divided into group 1 (1 superior parathyroid gland), group 2 (1 inferior parathyroid glands), group 3 (1 superior parathyroid gland and 1 inferior parathyroid gland) and group 4 (2 inferior parathyroid glands). The postoperative complications and serum parathyroid hormone and calcium were analyzed.A total of 368 patients were included in the study, among them 27, 243, 40, and 58 patients were divided into group 1, group 2, group 3, and group 4, respectively. Compared with those in group 2, the serum parathyroid hormones were higher at 1 week (2.98 ± 1.52 vs 2.42 ± 0.89, P = .049) and 2 weeks (3.49 ± 1.42 vs 2.8 ± 0.81, P = .019) postoperatively in group 1. There was also significantly different in the serum parathyroid hormone at 2 weeks postoperatively between group 3 and group 4 (2.95 ± 0.98 vs 2.58 ± 0.82, P = .047).The inferior parathyroid glands preserved in site recover faster than the superior parathyroid glands preserved in site.
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Affiliation(s)
- Bin Wang
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu
| | - Chun-Rong Zhu
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
- Department of Chemistry, School of Basic Medical Science, North Sichuan Medical College, Nanchong, China
| | - Hong Liu
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu
| | - Xin-Min Yao
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu
| | - Jian Wu
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu
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Boron A, Dennison JV, Dennison CB, Royall I, Scherer K. Parathyroid Auto-transplantation Mimicking Liposarcoma. Cureus 2019; 11:e5445. [PMID: 31632890 PMCID: PMC6797014 DOI: 10.7759/cureus.5445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Parathyroid autotransplantation is an increasingly common procedure given the increasing rate of hyperparathyroidism. However, post-autotransplantation imaging is not commonly performed and the imaging findings can mimic liposarcoma. Therefore, radiologists should be aware of the imaging characteristics of parathyroid autotransplantation. Here we discuss the CT and Tc99m-Sestamibi 4D-CT findings of parathyroid autotransplantation. We will also discuss the pathophysiology of liposarcoma and present the gross histological findings seen on pathology.
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Affiliation(s)
- Agnieszka Boron
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | | | | | - Ivey Royall
- Radiology - GME, AdventHealth Orlando, Orlando, USA
| | - Kurt Scherer
- Radiology - GME, AdventHealth Orlando, Orlando, USA
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Abstract
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.
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15
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Stevenson A, Mihai R. Patients' views about parathyroid transplantation for post-thyroidectomy hypoparathyroidism. Langenbecks Arch Surg 2018; 403:623-629. [PMID: 29971614 PMCID: PMC6132637 DOI: 10.1007/s00423-018-1693-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/26/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Permanent hypoparathyroidism (hypoPT) represents the most common postoperative complication associated with total thyroidectomy. Current treatment relies on high-dose calcium and/or vitamin D supplementation, but often this is insufficient and some patients remain symptomatic. Parathyroid allotransplantation is a new therapeutic option described recently in the literature. This study aims to investigate the patients' acceptability of parathyroid transplantation as a potential new treatment for hypoPT. METHOD Online survey of members of HypoParaUK, a support group for individuals affected by hypoPT. RESULTS Responses were received from 252 hypoPT patients. Majority declared to experience severe symptoms despite regular medical treatment. On a severity scale of 0-5, symptoms that were most troublesome were fatigue (3.8), low sense of well-being (3.5), and numbness/tingling (2.9). On a scale of 0-10, on average, their current quality of life (QoL) was 5 ± 3 and they expected this would improve to 7 ± 2 with correction of their hypoPT. Forty-four percent of patients were extremely interested in a potential technique involving intramuscular injection of parathyroid cell suspension compared to just 14% who were interested in the more invasive procedure of implantation of a parathyroid allograft into the forearm. The main concerns expressed were related to the possible need for immunosuppressive therapy. CONCLUSION Patients with severe symptomatic hypoPT seem interested to consider participation in a clinical trial exploring the feasibility and success rate of parathyroid transplantation.
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Affiliation(s)
| | - Radu Mihai
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Blenheim Head & Neck Unit, Churchill Cancer Centre, Old Road, Headington, Oxford, OX3 7LE, UK.
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Di Meo G, Sgaramella LI, Ferraro V, Prete FP, Gurrado A, Testini M. Parathyroid carcinoma in multiple endocrine neoplasm type 1 syndrome: case report and systematic literature review. Clin Exp Med 2018; 18:585-593. [DOI: 10.1007/s10238-018-0512-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/10/2018] [Indexed: 12/18/2022]
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Sitges-Serra A, Lorente-Poch L, Sancho J. Parathyroid autotransplantation in thyroid surgery. Langenbecks Arch Surg 2018; 403:309-315. [PMID: 29429003 DOI: 10.1007/s00423-018-1654-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/18/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Careful parathyroid gland dissection and in situ preservation was the time-honored approach to prevent parathyroid failure after total thyroidectomy. The relative success of parathyroid autotransplantation of hyperplastic parathyroid tissue in patients with renal or hereditary hyperparathyroidism did popularize the use of normal parathyroid tissue autografts during thyroidectomy to prevent permanent hypoparathyroidism. Proof of autograft function in this setting, however, is controversial. PURPOSE This narrative review aims at reviewing critically the current status of parathyroid autotransplantation during total thyroidectomy. It is also meant to analyze from the historical, methodological, and clinical points of view the claimed benefit of normal parathyroid gland autotransplantation. A focus is placed on the prevention of permanent hypoparathyroidism by parathyroid autotransplantation. CONCLUSIONS Liberal parathyroid autotransplantation was proposed in the mid 1970s but evidence of function is scarce. Proofs are accumulating that parathyroid autografts not only increase the rate of postoperative hypocalcemia, but may be also contribute to permanent hypoparathyroidism.
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Affiliation(s)
- Antonio Sitges-Serra
- Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain. .,Department of Surgery, Hospital del Mar, PasseigMarítim 25-29, 08003, Barcelona, Spain.
| | | | - Juan Sancho
- Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain
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Su A, Gong Y, Wu W, Gong R, Li Z, Zhu J. Does the number of parathyroid glands autotransplanted affect the incidence of hypoparathyroidism and recovery of parathyroid function? Surgery 2018; 164:S0039-6060(17)30928-5. [PMID: 29398031 DOI: 10.1016/j.surg.2017.12.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/08/2017] [Accepted: 12/23/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The relationship between the number of parathyroid glands autotransplanted and hypoparathyroidism as well as recovery of parathyroid function is not understood fully. The aim was to ascertain whether the number of autotransplanted glands affected the incidence of hypoparathyroidism and recovery of parathyroid function in long-term follow-up after thyroidectomy. METHODS A retrospective cohort study included all patients with papillary thyroid carcinoma who underwent first-time total thyroidectomy with central neck dissection between June 2012 and June 2015. The patients were divided into 4 groups (0, 1, 2, and 3) on the basis of the number of parathyroid glands autotransplanted. RESULTS Of the 766 patients, 283 (36.9%) had no gland autotransplanted, and 373 (48.7%), 97 (12.7%), and 13 (1.7%) had 1, 2, and 3 glands autotransplanted, respectively. More lymph nodes and more metastatic ones in the central compartment were retrieved in groups 2 and 3 (P < .05). With increasing number of autotransplanted glands, the incidence of transient hypoparathyroidism was 26.1%, 36.2%, 52.6%, and 84.6% (P < .05), and the incidence of permanent hypoparathyroidism was 1.8%, 1.1%, 1.0%, and 0% (P > .05). The recovery rates of serum parathyroid hormone concentration were 84.7%, 82.2%, 82.0%, and 79.2% after 2-year follow-up (P > .05). CONCLUSION Autotransplantation is an effective strategy for restoration of parathyroid function. Transient hypoparathyroidism is positively correlated to the number of autotransplanted parathyroid glands during total thyroidectomy with central neck dissection. There is no increase in permanent hypoparathyroidism in patients with a higher number of autotransplanted glands, despite more extensive lymph node disease. (Surgery 2018;161:XXX-XXX.).
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Affiliation(s)
- Anping Su
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yanping Gong
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wenshuang Wu
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Rixiang Gong
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Zhihui Li
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jingqiang Zhu
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Su A, Gong Y, Wu W, Gong R, Li Z, Zhu J. Effect of autotransplantation of a parathyroid gland on hypoparathyroidism after total thyroidectomy. Endocr Connect 2018; 7:286-294. [PMID: 29301864 PMCID: PMC8111321 DOI: 10.1530/ec-17-0313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 01/04/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND The effect of parathyroid autotransplantation on hypoparathyroidism is not fully understood. The purpose of the study was to determine the effect of autotransplantation of a parathyroid gland on the incidence of hypoparathyroidism and recovery of parathyroid function at 6 months after total thyroidectomy with central neck dissection for papillary thyroid carcinoma. METHODS All patients with autotransplantation of a parathyroid gland (no inadvertent parathyroidectomy) (group A), in situ preservation of all parathyroid glands (no autotransplantation and inadvertent parathyroidectomy) (group B) or inadvertent removal of a parathyroid gland (no autotransplantation) (group C) who underwent first-time total thyroidectomy with central neck dissection for papillary thyroid carcinoma between January 2013 and June 2016 were included retrospectively. RESULTS Of the 702 patients, 383, 297 and 22 were respectively included in the groups A, B and C. The overall rates of transient and permanent hypoparathyroidism were 37.6% and 1.0%. The incidence of transient hypoparathyroidism was 43.9, 29.0 and 45.5% (A vs B, P = 0.000; A vs C, P = 1.000), and the incidence of permanent hypoparathyroidism was 1.0, 0.7 and 4.5% (P > 0.05). The recovery rates of serum parathyroid hormone levels were 71.4, 72.2 and 66.0% at 6-month follow-up (P > 0.05). CONCLUSION Autotransplantation of a parathyroid gland does not affect the incidence of permanent hypoparathyroidism, but increases the risk of transient hypoparathyroidism when the rest of parathyroid glands are preserved in situ. At least 2 parathyroid glands should be preserved during total thyroidectomy with central neck dissection to prevent permanent hypoparathyroidism.
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Affiliation(s)
- Anping Su
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yanping Gong
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wenshuang Wu
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Rixiang Gong
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhihui Li
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
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Maeda SS, Moreira CA, Borba VZC, Bandeira F, Farias MLFD, Borges JLC, Paula FJAD, Vanderlei FAB, Montenegro FLDM, Santos RO, Ferraz-de-Souza B, Lazaretti-Castro M. Diagnosis and treatment of hypoparathyroidism: a position statement from the Brazilian Society of Endocrinology and Metabolism. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:106-124. [PMID: 29694629 PMCID: PMC10118685 DOI: 10.20945/2359-3997000000015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/14/2017] [Indexed: 11/23/2022]
Abstract
Objective To present an update on the diagnosis and treatment of hypoparathyroidism based on the most recent scientific evidence. Materials and methods The Department of Bone and Mineral Metabolism of the Sociedade Brasileira de Endocrinologia e Metabologia (SBEM; Brazilian Society of Endocrinology and Metabolism) was invited to prepare a document following the rules set by the Guidelines Program of the Associação Médica Brasileira (AMB; Brazilian Medical Association). Relevant papers were retrieved from the databases MEDLINE/PubMed, LILACS, and SciELO, and the evidence derived from each article was classified into recommendation levels according to scientific strength and study type. Conclusion An update on the recent scientific literature addressing hypoparathyroidism is presented to serve as a basis for the diagnosis and treatment of this condition in Brazil.
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Tonelli F, Marini F, Giusti F, Brandi ML. Total and Subtotal Parathyroidectomy in Young Patients With Multiple Endocrine Neoplasia Type 1-Related Primary Hyperparathyroidism: Potential Post-surgical Benefits and Complications. Front Endocrinol (Lausanne) 2018; 9:558. [PMID: 30319541 PMCID: PMC6165877 DOI: 10.3389/fendo.2018.00558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background: The choice of surgical treatment for patients with Multiple Endocrine Neoplasia type 1 (MEN1)-related primary hyperparathyroidism (PHPT) remains controversial and it has not been specifically addressed in young patients. Methods: This is a retrospective case series study. The study includes the surgical data and the follow-up of 38 patients younger than 30 years of age, all diagnosed with MEN1, collected and followed-up between 1991 and 2017 at the Regional Referral Center for Inherited Endocrine Tumors of the Tuscany Region, and operated by parathyroidectomy. Genetic and/or clinical MEN1 diagnosis was made before surgery in all patients. Subtotal (9/38 patients) or total parathyroidectomy with auto-transplantation (28/38 patients) were performed in all patients but one, in whom a single mediastinal adenoma was excised from the aorto-pulmonary window. All patients but one, who was operated in 2017, had a post-operatory follow-up of at least 12 months. Results: Total parathyroidectomy (TPTX), with auto-transplantation, was the most frequently adopted operation both as primary (20/38 patients) and secondary (8/38 patients) surgery, followed by subtotal parathyroidectomy (SPTX; 9/38 patients) and limited parathyroidectomy (1/38 patient). At follow-up, lasting a mean of 11.8 ± 6.6 years (range 0-23 years), no persistent PHPT was observed. PHPT recurred in 4/28 TPTX (14%) and in 2/9 SPTX (22%). Permanent hypoparathyroidism showed no statistically significant difference between the procedures (2/9 in SPTX and 5/28 in TPTX). Conclusions: Data from this retrospective study showed the efficacy of TPTX for the treatment of MEN1-PHPT, also in adolescent and young patients, showing, in our series, no risk of PHPT permanence and a longer disease-free period and, subsequently, the possibility to postpone re-intervention with respect to both limited PTX and SPTX. The risk of permanent hypoparathyroidism in TPTX was comparable to STPX, and could be mitigated over the years.
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Hicks G, George R, Sywak M. Short and long-term impact of parathyroid autotransplantation on parathyroid function after total thyroidectomy. Gland Surg 2017; 6:S75-S85. [PMID: 29322025 DOI: 10.21037/gs.2017.09.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The most common complication of total thyroidectomy is parathyroid insufficiency. Acute, transient, post-operative hypoparathyroidism increases length of hospitalization, morbidity and cost associated with total thyroidectomy. While permanent hypoparathyroidism poses a significant medical burden with lifetime medication, regular follow up and considerable disease burden related to chronic renal failure and other sequelae. Parathyroid autotransplantation has been demonstrated to result in biochemically functional grafts, leading to the procedures' common use during total thyroidectomy. The clearest indications for parathyroid auto transplantation are inadvertently removed or devascularized parathyroid glands. Some centers utilize routine autotransplantation to reduce the risk of permanent hypoparathyroidism. Novel fluorescence techniques to aid in parathyroid detection during thyroid surgery are under evaluation. This review aims to define the role and impact of parathyroid autotransplantation undertaken during total thyroidectomy.
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Affiliation(s)
- Gabrielle Hicks
- Endocrine Surgical Unit, University of Sydney, St Leonards, New South Wales, Australia
| | - Robert George
- Endocrine Surgical Unit, University of Sydney, St Leonards, New South Wales, Australia
| | - Mark Sywak
- Endocrine Surgical Unit, University of Sydney, St Leonards, New South Wales, Australia
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Kim BW, Kim SY, Lee YS, Kim SM, Chang HS, Park CS. Parathyroid score can predict the duration of required calcium supplementation after total thyroidectomy. PLoS One 2017; 12:e0174088. [PMID: 28350886 PMCID: PMC5369690 DOI: 10.1371/journal.pone.0174088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 03/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Postoperative hypoparathyroidism is the most common complication after total thyroidectomy, owing to unintentional injury or decreased blood flow to the parathyroid glands. Prediction of postoperative hypoparathyroidism would be helpful for surgeons to manage postoperative hypocalcemia. In this study, we scored the discoloration of the parathyroid glands using a new parathyroid scoring system and evaluated the correlation between the parathyroid score and duration of required calcium supplementation after total thyroidectomy. METHODS A total of 316 patients undergoing total thyroidectomy between November 2009 and April 2010 were enrolled in this retrospective study. Parathyroid scoring was performed by one experienced surgeon. The status of each of the 4 parathyroid glands was classified as normal color (3 points), slightly discolored (2 points), dark discoloration (1 point), or loss of the gland (0 points), resulting in possible total scores of 0-12. Serum parathyroid hormone (PTH), serum calcium, and ionized calcium concentrations were measured at 2 hours, 2 weeks, 3 months, 6 months, and 1 year after surgery. Patients were also divided into three groups based on the duration of required calcium supplementation: no required supplementation (n = 260, 82.3%), required supplementation for <6 months (n = 38, 12%), and required supplementation for ≥6 months (n = 18, 5.75%). RESULTS Parathyroid scores were positively correlated with ionized PTH concentrations at 2 hours (r = 0.053, p < 0.001), 2 weeks (r = 0.056, p < 0.001), 3 months (r = 0.032, p<0.001), 6 months (r = 0.072, p < 0.001), and 1 year (r = 0.071, p < 0.001) after thyroidectomy. Parathyroid scores were significantly and inversely associated with the duration of required calcium supplementation (p = 0.001). CONCLUSIONS Parathyroid scores at the end of surgery might be helpful for predicting the degree of postoperative hypocalcemia after total thyroidetomy.
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Affiliation(s)
- Bup-Woo Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo Young Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Mo Kim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hang-Seok Chang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Cheong Soo Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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The Association of Discolored Parathyroid Glands and Hypoparathyroidism Following Total Thyroidectomy. World J Surg 2017; 40:1611-7. [PMID: 26908241 DOI: 10.1007/s00268-016-3462-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND It remains uncertain whether a parathyroid gland (PG) that appears darkened or severely bruised but still has an attached vascular pedicle should be left in situ or taken out and auto-transplanted following total thyroidectomy. Our study aimed to examine the impact of discolored PGs (DPGs) on short- and long-term hypoparathyroidism. METHODS One hundred and three patients who underwent total thyroidectomy with 4 clearly identified PGs were analyzed. Location (superior/inferior) and color of each PG were recorded. Patients without DPG were grouped into I while those with 1-2 DPGs and ≥3 DPGs were grouped into II and III, respectively. Transient hypoparathyroidism meant adjusted Ca <2.00 mol/L 24 h after surgery and/or need for supplements. Protracted hypoparathyroidism meant a subnormal PTH at 4-6 weeks and/or supplements >6 weeks. Permanent hypoparathyroidism meant supplements ≥1 year. RESULTS Relative to I, group III had greater adjusted Ca drop at postoperative 1-h (p = 0.012), 24-h (p < 0.001) and lower day-1 PTH (p = 0.015). Having ≥3 DPGs (OR 14.00, 95 % CI 1.575-124.474, p = 0.018) was an independent factor of transient hypoparathyroidism. However, permanent hypoparathyroidism rate was higher than in group I than II (p = 0.019). Eight patients (25.8 %) in group I had undetectable day-1 PTH, while none in group III had undetectable day-1 PTH. Graves' disease/toxic goiter (OR 15.166, 95 % CI 2.594-88.661, p = 0.003) and excised gland weight (OR 1.028, 95 % CI 1.010-1.046, p = 0.003) were independent factors of ≥3 DPGs. CONCLUSIONS PG discoloration is associated with transient hypoparathyroidism while normal colored PG with seemingly adequate blood supply does not always imply functionally normal gland. These findings highlights the need for a real-time intraoperative method to assess PG viability.
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Cavallaro G, Iorio O, Centanni M, Gargano L, Del Duca S, Gurrado A, Porta N, Petrozza V, Testini M, De Toma G. Parathyroid reimplantation with PR-FaST technique in unselected patients during thyroidectomy. A case series with long term follow up confirming graft vitality and parathormone production. Int J Surg 2017; 39:202-205. [PMID: 28167381 DOI: 10.1016/j.ijsu.2017.01.117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Parathyroid damage or unintentional excision still affect thyroid surgery and may cause permanent hypoparathyroidism. The only way to recover the excised or ischemic gland functionality is still reimplantation. Many sites of reimplantation have been described, each of one showing both advantages and drawbacks. The aim of this study is to verify results of a new procedure called PR-FaST: Parathyroid Reimplantation in Forearm Subcutaneous Tissue, in a series of unselected patients after long-term follow-up. MATERIALS AND METHODS From January 2013 to October 2015, 296 consecutive total thyroidectomies have been performed) to treat both benign and malignant thyroid diseases. in 42 cases (14.1%), due to an insufficient blood supply or accidental removal, one parathyroid gland was reimplanted with the PR-FaST technique. Post-operative evaluation was carried out by: total serum calcium (Ca), magnesium (Mg) and phosphorus (P) analysis in the 1st and 2nd postoperative days; Ca, Mg, P and serum iPTH from both arms analysis one week after surgery; Ca and iPTH measurement from both arms 1 months, 3, 6 and 12 months after surgery. RESULTS We observed transient hypocalcemia requiring calcium replacement therapy in 5 on 42 (11.9%) patients submitted to PR-FaST. No case of permanent hypoparathyroidism was reported. At 1 week after surgery, only 20 patients (47.6%) showed graft vitality, while the number of patients showing graft vitality arised to 33 (79%) after 1 month and to 39 (92.8%) after three and six months. At 1 year 38 (90.5%) patients showed good graft functionality. Considering levels of serum iPTH from both arms, we observed that in case of graft functionality, samples from reimplanted arm revealed in almost all cases values at least 2-3 folds higher than in non reimplanted arm. CONCLUSIONS Results from this prospective evaluation suggest that PR-FaST is a safe and effective procedure, with potential advantages when compared to other techniques of parathyroid reimplantation, that are mainly the possibility to evaluate graft functionality in the follow-up and the easy and well reproducible technique. Furthermore, it can be applied, when needed, to potentially all patients undergoing thyroidectomy.
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Affiliation(s)
| | - Olga Iorio
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Lucilla Gargano
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Susanna Del Duca
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Angela Gurrado
- Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Natale Porta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Giorgio De Toma
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
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Lorente-Poch L, Sancho J, Muñoz JL, Gallego-Otaegui L, Martínez-Ruiz C, Sitges-Serra A. Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy. Langenbecks Arch Surg 2017; 402:281-287. [PMID: 28064342 DOI: 10.1007/s00423-016-1548-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/26/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Parathyroid autotransplantation during total thyroidectomy leads to higher rates of postoperative hypocalcaemia. It has been argued, however, that it prevents permanent hypoparathyroidism. The impact of autografted normal parathyroid gland fragments on long-term parathyroid status has not been assessed properly. To clarify this, the short- and long-term parathyroid function was assessed in patients with three glands remaining in situ after total thyroidectomy, in whom the fourth gland was either autotransplanted (Tx) or accidentally resected (AR). METHODS Consecutive patients (n = 669) undergoing first-time total thyroidectomy were prospectively studied recording the number of parathyroid glands remaining in situ: PGRIS =4-(glands autografted + glands in the specimen). The study was focused on the subgroup of 186 patients with three parathyroid glands remaining in situ as a result of either accidental resection (AR, n = 76) or autotransplantation into the sternocleidomastoid muscle (Tx, n = 110). Prevalence of postoperative hypocalcaemia, protracted, and permanent hypoparathyroidism were compared between the two groups. Demographic, disease-related, laboratory, and surgical variables were recorded. All patients were followed for at least 1 year. RESULTS Both groups were comparable in terms of disease and extent of surgery. Mean postoperative serum calcium was the same (AR: 1.97 ± 0.2 vs Tx: 1.97 ± 0.22 mmol/L). Rates of protracted (AR: 24% vs Tx: 25.5%) and permanent hypoparathyroidism (AR: 5.3% vs Tx: 7.3%) were similar in both groups. CONCLUSIONS The prevalence of parathyroid failure syndromes after total thyroidectomy was similar whether a parathyroid gland was inadvertently excised or autotransplanted. Autotransplantation did not influence the permanent hypoparathyroidism rate.
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Affiliation(s)
- Leyre Lorente-Poch
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Juan Sancho
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Jose Luis Muñoz
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Lander Gallego-Otaegui
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Carlos Martínez-Ruiz
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Antonio Sitges-Serra
- Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
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Neagoe RM, Cvasciuc IT, Muresan M, Sala DT. INCIDENTAL PARATHYROIDECTOMY DURING THYROID SURGERY - RISK, PREVENTION AND CONTROVERSIES; AN EVIDENCE-BASED REVIEW. ACTA ENDOCRINOLOGICA-BUCHAREST 2017; 13:467-475. [PMID: 31149218 DOI: 10.4183/aeb.2017.467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Postoperative hypocalcemia after thyroid surgery has a high prevalence ( 16-55% in different series). Incidental parathyroidectomy (IP) is a less discussed complication of thyroidectomy with consequences not properly defined. The aim of our study was to find incidence, risk factors and how to prevent IP. Methods Extensive search of English literature publications via PubMed was performed and 73 papers from 1980 to 2017 were analysed using the GRADE system/classification, quality of evidence was classified as "strong" when the result is highly unlikely to change existing recommendation and "weak" when opposite. Results Incidence of IP is 3.7-24.9%, while prevalence of permanent hypoparathyroidism is less frequent 6-12%. Direct relation between IP and hypoparathyroidism/hypocalcemia remains controversial. Female patients, ectopic parathyroids, small thyroids, Graves', malignancy, redo surgeries and total thyroidectomy favour IP. Routine visualization of parathyroids, new hemostatic devices, magnifying instruments and fluorescence can prevent incidental removal of parathyroids. Incidence of IP during videoassisted or robotic thyroidectomies was similar to open procedures. High volume, experienced and younger surgeons have lower complication rates (including hypoparathyroidism). Conclusions Incidental parathyroidectomy is more frequent than we might have expected. It should be avoided and parathyroid glands should be kept in situ. Majority of studies are retrospective (low degree of evidence according to previous mentioned GRADE classification) and further meta-analysis or randomized control studies are welcome in order to define the impact of incidental removal of parathyroids on postoperative outcome.
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Affiliation(s)
- R M Neagoe
- University of Medicine and Pharmacy, Second Department of Surgery, Targu Mures, Romania
| | - I T Cvasciuc
- Leeds Teaching Hospitals, Dept. of Endocrine Surgery, Leeds, United Kingdom of Great Britain and Northern Ireland
| | - M Muresan
- University of Medicine and Pharmacy, General Surgery, Targu Mures, Romania
| | - D T Sala
- Emergency Mures County Hospital, Second Department of Surgery, Targu Mures, Romania
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Wolff F, Gervy C, Cavalier E, Bergmann P, Cotton F, Heureux M, Corvilain B, Badot V. When obtaining a blood sample from the right arm was not the right thing to do: a case of elevated parathyroid hormone levels 27 years after thyroidectomy. Clin Chem Lab Med 2016; 54:e369-e371. [PMID: 27244879 DOI: 10.1515/cclm-2016-0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/03/2016] [Indexed: 11/15/2022]
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Famà F, Cicciù M, Polito F, Cascio A, Gioffré-Florio M, Piquard A, Saint-Marc O, Sindoni A. Parathyroid Autotransplantation During Thyroid Surgery: A Novel Technique Using a Cell Culture Nutrient Solution. World J Surg 2016; 41:457-463. [PMID: 27734084 DOI: 10.1007/s00268-016-3754-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Parathyroid autotransplantation is an easy procedure with a low complication rate. We adopted the transplantation into the sternocleidomastoid muscle, which allows an easier and time-saving surgical procedure using the same surgical incision. METHODS In this study, we retrospectively reviewed the records of 396 consecutive patients, who underwent total thyroidectomy for benign thyroid disease. In all cases in which a parathyroid was damaged or inadvertently removed, the gland was transplanted; before the autotransplantation, the parathyroid tissue was put in a cell culture nutrient solution for 5 min, afterward fragmented, and then was transplanted in the sternocleidomastoid muscle. To demonstrate a beneficial effect of the cell nutrient solution step, we compared data of transplanted patients with a control group of cases (n = 190) undergoing a standard immediate autotransplantation. RESULTS We divided patients in two main groups: group A (n = 160) including subjects that underwent one or more parathyroid gland autotransplantation using the cell nutrient solution, and group B (n = 236) concerning those who were not transplanted. Among patients, 62 hypocalcemias occurred, 40 in the group A and 22 in the group B (P < 0.001): 91.9 % were transient and 8.1 % (5 patients) definitive, all pertaining to the group B. Among controls (group C), 42 hypocalcemias occurred (P = 0.616 vs. group A and P = 0.002 vs. group B) and 3/42 became definitive (P = 0.096 vs. group A and P = 0.121 vs. group B). All differences concerning pre- and postoperative calcium values were statistically significant (P < 0.001). CONCLUSIONS We recommend the routine parathyroid autotransplantation, when a vascular damage is certain or suspected, in order to reduce the rate of permanent hypoparathyroidism, using a cell culture nutrient solution before gland transplantation.
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Affiliation(s)
- Fausto Famà
- Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy. .,Complesso MITO, Residenza Ginestre F/2, 98151, Messina, Italy.
| | - Marco Cicciù
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Francesca Polito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Antonio Cascio
- Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Maria Gioffré-Florio
- Department of Human Pathology, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
| | - Arnaud Piquard
- Department of General, Endocrine and Thoracic Surgery, Regional Hospital of Orleans, 14, Avenue de l'Hopital, 45067, Orléans (cedex 2), France
| | - Olivier Saint-Marc
- Department of General, Endocrine and Thoracic Surgery, Regional Hospital of Orleans, 14, Avenue de l'Hopital, 45067, Orléans (cedex 2), France
| | - Alessandro Sindoni
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University Hospital of Messina, Via Consolare Valeria, 1, 98125, Messina, Italy
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Yu W, Zhu L, Xu G, Song Y, Li G, Zhang N. Potential role of carbon nanoparticles in protection of parathyroid glands in patients with papillary thyroid cancer. Medicine (Baltimore) 2016; 95:e5002. [PMID: 27759629 PMCID: PMC5079313 DOI: 10.1097/md.0000000000005002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
As a novel type of lymphatic tracer, carbon nanoparticles (CNs) were reported not to stain parathyroid glands (PGs) into black, so it may have a clinical potential in protection of PGs during thyroidectomy. The purpose of this study was to investigate the clinical application and significance of CN in protection of PGs from surrounding tissues.A total of 82 consecutive patients were enrolled into this study and were divided into CN group and control group. Parathyroid function (hypoparathyroidism and hypocalcemia) was evaluated.The identification rates of PGs (≤2) and PGs (≥3) were 24.4% and 75.6% in the CN group and 46.3% and 53.7% in the control group, respectively. The difference in the identification rates between the 2 groups was statistically significant (P = 0.038). Pathological results revealed 3 accidental PGs resection occurred in the CN group, whereas 9 accidental PGs removal occurred in the control group. The difference was statistically significant (P = 0.046). Moreover, the incidence of the patients with hypoparathyroidism was statistically significant between the 2 groups (36.6% in CN group vs 53.7% in control group, P = 0.043) at day 1, but not at day 7 (P = 0.424).CN may have a potential in protecting PGs clinically.
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Affiliation(s)
- Wenbin Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing
- Correspondence: Wenbin Yu, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing, China (e-mail: )
| | - Lijun Zhu
- Department of Oral and Maxillofacial Surgery, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guohui Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing
| | - Yuntao Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing
| | - Guojun Li
- Department of Head and Neck Surgery
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naisong Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing
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Kim BK, Lee J, Sun WY. Recurrent hyperparathyroidism due to proliferation of autotransplanted parathyroid tissue in a multiple endocrine neoplasia type 2A patient. Ann Surg Treat Res 2016; 91:145-8. [PMID: 27617256 PMCID: PMC5016605 DOI: 10.4174/astr.2016.91.3.145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/23/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022] Open
Abstract
About 20%–30% of all cases of multiple endocrine neoplasia type 2A (MEN 2A) is accompanied by primary hyperparathyroidism. These patients undergo parathyroidectomy and, if needed, autotransplantation. In rare cases, autotransplanted parathyroid tissues can cause hypoparathyroidism due to failure of transplantation or hyperparathyroidism due to proliferation of the transplanted tissue. A 68-year-old female with MEN 2A underwent left adrenalectomy for pheochromocytoma 15 years prior to presentation and total thyroidectomy, central and right lateral neck lymph node dissection, and subtotal parathyroidectomy with autotransplantation for medullary thyroid cancer and primary hyperparathyroidism 6 years previous. Recently, a doubtful parathyroid adenoma was detected in the left sternocleidomastoid muscle on ultrasonography and on an additional sestamibi scan. The mass was excised and histologically confirmed as parathyroid adenoma. This is a very rare case, and it suggests that long-term regular monitoring of serum calcium and intact parathyroid hormone levels is necessary after parathyroid autotransplantation.
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Affiliation(s)
- Bong Kyun Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jina Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Young Sun
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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