Abstract
Surgery of parathyroid revolves around the management of hyperparathyroidism (HPT). In most cases, occurrence is sporadic rather than familial, and 80–85% of cases of sporadic primary HPT are caused by a solitary parathyroid adenoma. The diagnosis is made by hypercalcaemia with an inappropriately elevated parathyroid hormone (PTH) level and a 24-hour urine calcium excretion level that is normal or high. Improved assay for PTH has led to earlier detection of HPT and has been responsible for the apparent increase in the prevalence of the disorder. An improvement in preoperative localisation studies as well as the development of a rapid intraoperative PTH assay has changed the approach to parathyroid surgery in the last two decades. This article provides a brief overview of management of primary HPT.
Similar content being viewed by others
References
Modorai B, Sawyer A, Ellis H (2004) The Glands of Owen. J R Soc Med 97:494–495
Mandl F (1926) Klinisches und Experimenteles zur Frage der lakalisierten und generalisiereten Osteitis Fibrosa. Arch Klin Chir 143:1
Moore MA, Owen JJ (1967) Experimental studies on the development of the thymus. J Exp Med 126(4):715–726
Libutti SK, Alexander HR, Bartlett DL, et al. (1999) Kinetic analysis of rapid intraoperative parathyroid hormone assay in patients during operation for hyperparathyroidism. Surgery 126(6):1145–1150; discussion 1150–1151
Beard CM, Heath H, O’Fallon WM, Anderson JA, Earle JD, Melton LJ (1989) Therapeutic radiation and hyperparathyroidism. A case-control study in Rochester. Minn Arch Intern Med 149(8):1887–1890
Cohen J, Gierlowski TC, Schneider AB (1990) A prospective study of hyperparathyroidism in individuals exposed to radiation in childhood. JAMA 264(5):581–584
Garfinkel PE, Ezrin C, Stancer HC (1973) Hypothyroidism and hyperparathyroidism associated with lithium. Lancet 2(7824):331–332
McIntosh WB, Horn EH, Mathieson LM, Sumner D (1987) The prevalence, mechanism and clinical significance of lithium-induced hypercalcaemia. Med Lab Sci 44(2):115–118
Arnold A, Shattuck TM, Mallya SM, et al. (2002) Molecular pathogenesis of primary hyperparathyroidism. J Bone Miner Res 17(Suppl 2):N30–N36
Shane E (1994) Parathyroid carcinoma. In The Parathyroids: Basic and Clinical Concepts. Bilezikian JP, Marcus R, Levine MA (Eds.), Raven, New York
Silverberg SJ, Bilezikian JP (2003) Incipient primary hyperparathyroidism: A “forme fruste” of an old disease. J Clin Endocrinol Metab 88(11):5348–5352
Carnaille BM, Pattou FN, Oudar C, et al. (1996) Parathyroid incidentalomas in normocalcemic patients during thyroid surgery. World J Surg 20(7):830–834; discussion 834
Proceedings of the NIH Consensus Development Conference on diagnosis and management of asymptomatic primary hyperparathyroidism; Bethesda, Maryland, October 29–31, 1990. Miner Res 1991;6(Suppl 2):S1–S166
Bilezikian JP, Potts JT Jr, Fuleihan Gel-H, et al. (2002) Summary statement from a workshop on asymptomatic primary hyperparathyroidism: A perspective for the 21st century. J Clin Endocrinol Metab 87(12):5353–5361
Coakley AJ, Kettle AG, Wells CP, et al. (1989) Tcm sestamibi — a new agent for parathyroid imaging. Nucl Med Commun 10(11):791–794
Van Heerden JA, Grant CS (1991) Surgical treatment of primary hyperparathyroidism: An institutional perspective. World J Surg 15:688–692
Russel CF, Laird JD, Fergusson WR (1990) Scan-directed unilateral cervical exploration for parathyroid adenoma: A legitimate approach ? World J Surg 14:406–409
Goldstein RE, Blevins L, Delbeke D, et al. (2000) Effect of minimally invasive radioguided parathyroidectomy on efficacy, length of stay and costs in management of hyperparathyroidism. Ann Surg 231:732–742
Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875
Gagner M, Rubino F (2004) Endoscopic parathyroidectomy. In: Endocrine Surgery. Schwartz AE, Pertsemlidis D, Gagner M (Eds.), Marcel Dekker, New York 289–296
Miccoli P, Bendinelli C, Conte M (1998) Endoscopic parathyroidectomy by a gasless approach. J Laparoendosc Adv Surg Tech A 8:189–194
Udelsman R, Donovan PI, Sokoll LJ (2000) One hundred minimally invasive parathyroid explorations. Ann Surg 232:331–339
Shoback DM, et al. (2001) An evaluation of the calcimimetic AMG 073 in patients with hypercalcemia and primary hyperparathyroidism. J Bone Miner Res 16:S303
Shukla S, Kaushal M, Shukla SK (2008) Primary hyperparathyroidism: retrospective 10-year study of 32 cases. Indian J Surg 70:169–174
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vittal, S.K., Sai Vishnupriya, V., Sucharitha, V. et al. Surgery of parathyroid. Indian J Surg 72, 10–15 (2010). https://doi.org/10.1007/s12262-010-0002-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-010-0002-y