Advertisement

World Journal of Surgery

, Volume 40, Issue 3, pp 595–599 | Cite as

Location Frequency of Missed Parathyroid Glands After Parathyroidectomy in Patients with Persistent or Recurrent Secondary Hyperparathyroidism

  • Manabu OkadaEmail author
  • Yoshihiro Tominaga
  • Takayuki Yamamoto
  • Takahisa Hiramitsu
  • Shunji Narumi
  • Yoshihiko Watarai
Original Scientific Report

Abstract

Background

Reoperative parathyroidectomy (RPTX) because parathyroid glands have been missed is frequently required in patients with secondary hyperparathyroidism (SHPT). The usual locations of these missed glands in patients with SHPT are yet to be fully elucidated.

Methods

We retrospectively investigated the locations of missed glands in 165 patients who underwent RPTX for persistent or recurrent SHPT at our institution from August 1982 to July 2014. At our institution, total parathyroidectomy with forearm autograft is the routine operative procedure for SHPT. We also routinely resect the thymic tongue.

Results

Of 165 patients, 82 underwent initial parathyroidectomy at our institution (Group A), and the remaining 83 underwent initial parathyroidectomy at other institutions (Group B). A total of 239 parathyroid glands were resected (Group A, 93; Group B, 146). Missed glands were most commonly located in the mediastinum (Group A, 22/93) and the thymic tongue (Group B, 31/146).

Conclusions

In patients with persistent or recurrent SHPT, ectopic parathyroid glands are frequently located in the mediastinum and thymic tongue. Therefore, resecting the thymic tongue during the initial operation may reduce the need for RPTX.

Keywords

Chronic Kidney Disease Parathyroid Gland Secondary Hyperparathyroidism Parathyroid Tissue Total Parathyroidectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Block GA, Klassen PS, Lazarus JM et al (2004) Mineral metabolism, mortality, and morbidity in maintenance hemodialysis patients. J Am Soc Nephrol 15:2208–2218CrossRefPubMedGoogle Scholar
  2. 2.
    Stevens LA, Djurdjev O, Cardew S et al (2004) Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am Soc Nephrol 15:770–779CrossRefPubMedGoogle Scholar
  3. 3.
    Block GA, Shearon EH, Levin NW et al (1998) Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney 31:607–617CrossRefGoogle Scholar
  4. 4.
    Block GA, Port FK (2000) Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney 35:1226–1237CrossRefGoogle Scholar
  5. 5.
    Goodman WG (2002) Calcimimetic agents and secondary hyperparathyroidism: treatment and prevention. Nephrol Dial Transplant 17:204–207CrossRefPubMedGoogle Scholar
  6. 6.
    Cunningham J, Danese M, Olson K et al (2005) Effect of the calcimimetic cinacalcet HCl on cardiovascular disease, fracture, and health-related quality of life in secondary hyperparathyroidism. Kidney Int 68:1793–1800CrossRefPubMedGoogle Scholar
  7. 7.
    Tominaga Y, Kakuta T, Yasunaga C, et al Evaluation of parathyroidectomy for secondary and tertiary hyperparathyroidism in Japan: by the Parathyroid Surgeons’ Society of Japan. Ther Apher Dial (forthcoming)Google Scholar
  8. 8.
    Ballinger AE, Palmer SC, Nistor I et al (2014) Calcimimetics for secondary hyperparathyroidism in chronic kidney disease patients. Cochrane Database Syst Rev 12:CD006254. doi: 10.1002/14651858.CD006254 PubMedGoogle Scholar
  9. 9.
    Sharma A, Marshall TS, Khan SS et al (2014) Cost effectiveness of paricalcitol versus cinacalcet with low-dose vitamin D for management of secondary hyperparathyroidism in haemodialysis patients in the USA. Clin Drug Investig 34:107–115. doi: 10.1007/s40261-013-0151-4 PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Ghani A, Baxter P (2012) Surgical parathyroidectomy versus cinacalcet therapy: in the management of secondary hyperparathyroidism. Otolaryngol Head Neck Surg 146:220–225. doi: 10.1177/0194599811428272 CrossRefPubMedGoogle Scholar
  11. 11.
    Foundation Kidney (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am. J kid Dis 42:S1–S140Google Scholar
  12. 12.
    Guideline working Group (2008) Japanese Society for Dialysis Therapy: clinical practice guideline for management of secondary hyperparathyroidism in chronic dialysis patients. Ther Apher Dial 12:514–525. doi: 10.1111/j.1744-9987.2008.00648.x CrossRefGoogle Scholar
  13. 13.
    Matsuoka S, Tominaga Y, Sato T et al (2007) Quick-intraoperative bio-intact PTH assay at parathyroidectomy for secondary hyperparathyroidism. World J Surg 31:824–831CrossRefPubMedGoogle Scholar
  14. 14.
    Hiramitsu T, Tominaga Y, Okada M et al (2015) A retrospective study of the impact of intraoperative intact parathyroid hormone monitoring during total parathyroidectomy for secondary hyperparathyroidism. Medicine 94(29):e1213. doi: 10.1097/MD.0000000000001213 PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Tominaga Y, Matsuoka S, Uno N et al (2010) Removal of autografted parathyroid tissue for recurrent renal hyperparathyroidism in hemodialysis patients. World J Surg 34:1312–1317CrossRefPubMedGoogle Scholar
  16. 16.
    Numano M, Tominaga Y, Uchida K et al (1998) Surgical significance of supernumerary parathyroid glands in renal hyperparathyroidism. World J Surg 22:1098–1102CrossRefPubMedGoogle Scholar
  17. 17.
    Pattou FN, Pellissier LC, Neol C et al (2000) Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism. World J Surg 24:1330–1334CrossRefPubMedGoogle Scholar
  18. 18.
    Akerstrom G, Malmaeus J, Bergstrom R (1984) Surgical anatomy of human parathyroid glands. Surgery 95:14–21PubMedGoogle Scholar
  19. 19.
    Tominaga Y (2013) Surgical management of secondary and tertiary hyperparathyroidism. In: Gregory WR (ed) Surgery of the thyroid and parathyroid glands, 2nd edn. Elsevier Saunders, Philadelphia, pp 639–647Google Scholar
  20. 20.
    Uno N, Tominaga Y, Matsuoka S et al (2008) Incidence of parathyroid glands located in thymus in patients with renal hyperparathyroidism. World J Surg 32:2516–2519CrossRefPubMedGoogle Scholar
  21. 21.
    Tominaga Y, Katayama A, Sato T et al (2003) Re-operation is frequently required when parathyroid glands remain after initial parathyroidectomy for advanced secondary hyperparathyroidism in uraemic patients. Nephrol Dial Transplant 18(Suppl 3):iii65–iii70PubMedGoogle Scholar
  22. 22.
    Elliot JM, Raymon HG, Quan-Yan D (2013) Guide to preoperative parathyroid localization testing. In: Gregory WR (ed) Surgery of the thyroid and parathyroid glands, 2nd edn. Elsevier Saunders, Philadelphia, pp 539–545Google Scholar

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Manabu Okada
    • 1
    Email author
  • Yoshihiro Tominaga
    • 1
  • Takayuki Yamamoto
    • 1
  • Takahisa Hiramitsu
    • 1
  • Shunji Narumi
    • 1
  • Yoshihiko Watarai
    • 1
  1. 1.Department of Transplantation and Endocrine SurgeryNagoya 2nd Red Cross HospitalNagoyaJapan

Personalised recommendations