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Surgical management of secondary hyperparathyroidism: how to effectively reduce recurrence at the time of primary surgery

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Abstract

Background

Successful parathyroidectomy (PTX) often results in a dramatic drop in the parathyroid hormone (PTH) levels, relieves the patient from clinical symptoms, and reduces mortality. Although PTX is generally a successful treatment for progressive secondary hyperparathyroidism (SHPT) patients subjected to surgery, a significant proportion develops recurrent SHPT following PTX.

Key message

SHPT requiring PTX occurs more commonly in progressive chronic kidney disease and in long-term lithium therapy. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages, and disadvantages. Although PTX offers the highest percentage cure for SHPT, compared to all other medical and surgical treatment, recurrent hyperparathyroidism can be observed in some patients dependent on follow-up time. A literature review and analysis of recent data regarding how to reduce recurrence of SHPT at the time of primary surgery was performed. The current literature and our own experience in the field have confirmed that pre-operative imaging, thymectomy, stereo magnifier, and surgical procedure may effectively reduce recurrence of SHPT at the time of primary surgery.

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References

  1. Fraser WD (2009) Hyperparathyroidism. Lancet 374(9684):145–158

    Article  CAS  PubMed  Google Scholar 

  2. Tominaga Y, Sato K, Tanaka Y et al (1995) Histopathology and pathophysiology of secondary hyperparathyroidism due to chronic renal failure. Clin Nephrol 44(Suppl 1):S42–S47

    PubMed  Google Scholar 

  3. Felsenfeld AJ (1997) Considerations for the treatment of secondary hyperparathyroidism in renal failure. J Am Soc Nephrol 8(6):993–1004

    CAS  PubMed  Google Scholar 

  4. Tominaga Y, Tanaka Y (1997) Histopathology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 13(2):78–86

    Article  CAS  PubMed  Google Scholar 

  5. Schneider R, Slater EP, Karakas E et al (2012) Initial parathyroid surgery in 606 patients with renal hyperparathyroidism. World J Surg 36(2):318–326

    Article  PubMed  Google Scholar 

  6. Komaba H, Taniguchi M, Wada A et al (2015) Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int 88(2):350–359

    Article  PubMed  Google Scholar 

  7. Giordano A, Rubello D, Casara D (2001) New trends in parathyroid scintigraphy. Eur J Nucl Med 28(9):1409–1420

    Article  CAS  PubMed  Google Scholar 

  8. Hindie E, Ugur O, Fuster D et al (2009) 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging 36(7):1201–1216

    Article  PubMed  Google Scholar 

  9. Milas M, Weber CJ (2004) Near-total parathyroidectomy is beneficial for patients with secondary and tertiary hyperparathyroidism. Surgery 136(6):1252–1260

    Article  PubMed  Google Scholar 

  10. Wimmer G, Profanter C, Kovacs P et al (2010) CT–MIBI-SPECT image fusion predicts multiglandular disease in hyperparathyroidism. Langenbecks Arch Surg 395(1):73–80

    Article  PubMed  Google Scholar 

  11. Hindie E, Urena P, Jeanguillaume C et al (1999) Preoperative imaging of parathyroid glands with technetium-99m-labelled sestamibi and iodine-123 subtraction scanning in secondary hyperparathyroidism. Lancet 353(9171):2200–2204

    Article  CAS  PubMed  Google Scholar 

  12. Neumann DR, Esselstyn CB Jr, Madera A et al (1998) Parathyroid detection in secondary hyperparathyroidism with 123I/99mTc-sestamibi subtraction single photon emission computed tomography. J Clin Endocrinol Metab 83(11):3867–3871

    Article  CAS  PubMed  Google Scholar 

  13. Krausz Y, Bettman L, Guralnik L et al (2006) Technetium-99m-MIBI SPECT/CT in primary hyperparathyroidism. World J Surg 30(1):76–83

    Article  PubMed  Google Scholar 

  14. Yang J, Hao R, Yuan L et al (2014) Value of dual-phase (99m)Tc-sestamibi scintigraphy with neck and thoracic SPECT/CT in secondary hyperparathyroidism. AJR Am J Roentgenol 202(1):180–184

    Article  PubMed  Google Scholar 

  15. Proye CAG, Carnaille B, Bizard JP et al (1992) Multiglandular disease in seemingly sporadic primary hyperparathyroidism revisited: where are we in the early 1990s? A plea against unilateral parathyroid exploration. Surgery 112:1118

    CAS  PubMed  Google Scholar 

  16. Chen J, Wang JD (2014) Radioguided parathyroidectomy in patients with secondary hyperparathyroidism due to chronic renal failure. Nucl Med Commun 35(4):391–397

    Article  CAS  PubMed  Google Scholar 

  17. Fuster D, Ybarra J, Ortin J et al (2006) Role of pre-operative imaging using 99mTc-MIBI and neck ultrasound in patients with secondary hyperparathyroidism who are candidates for subtotal parathyroidectomy. Eur J Nucl Med Mol Imaging 33(4):467–473

    Article  PubMed  Google Scholar 

  18. Blackburn CC, Manley NR (2004) Developing a new paradigm for thymus organogenesis. Nat Rev Immunol 4(4):278–289

    Article  CAS  PubMed  Google Scholar 

  19. Maret A, Bourdeau I, Ding C et al (2004) Expression of GCMB by intrathymic parathyroid hormone-secreting adenomas indicates their parathyroid cell origin. J Clin Endocrinol Metab 89(1):8–12

    Article  CAS  PubMed  Google Scholar 

  20. Liu Z, Farley A, Chen L et al (2010) Thymus-associated parathyroid hormone has two cellular origins with distinct endocrine and immunological functions. PLoS Genet 6(12):e1001251

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Gunther T, Chen ZF, Kim J et al (2000) Genetic ablation of parathyroid glands reveals another source of parathyroid hormone. Nature 406(6792):199–203

    Article  CAS  PubMed  Google Scholar 

  22. Madorin C, Owen RP, Fraser WD et al (2012) The surgical management of renal hyperparathyroidism. Eur Arch Otorhinolaryngol 269(6):1565–1576

    Article  PubMed  Google Scholar 

  23. Powell AC, Alexander HR, Pingpank JF et al (2008) The utility of routine transcervical thymectomy for multiple endocrine neoplasia 1-related hyperparathyroidism. Surgery 144(6):878–883 (discussion 883–884)

    Article  PubMed  PubMed Central  Google Scholar 

  24. Welch K, McHenry CR (2012) The role of transcervical thymectomy in patients with hyperparathyroidism. Am J Surg 203(3):292–295 (discussion 295–296)

    Article  PubMed  Google Scholar 

  25. Schlosser K, Endres N, Celik I et al (2007) Surgical treatment of tertiary hyperparathyroidism: the choice of procedure matters! World J Surg 31(10):1947–1953

    Article  PubMed  Google Scholar 

  26. Well SA Jr, Gunnells JC, Shelburne JD et al (1975) Transplantation of the parathyroid glands in man: clinical indications and results. Surgery 78(1):34–44

    Google Scholar 

  27. 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(6):1312–1317

    Article  PubMed  Google Scholar 

  28. He Q, Zhuang D, Zheng L et al (2014) Total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation as the treatment of choice for secondary hyperparathyroidism: a single-center experience. BMC Surg 14:26

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ogg CS (1967) Total parathyroidectomy in treatment of secondary (renal) hyperparathyroidism. Br Med J 4(5575):331–334

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Stracke S, Keller F, Steinbach G et al (2009) Long-term outcome after total parathyroidectomy for the management of secondary hyperparathyroidism. Nephron Clin Pract 111(2):c102–c109

    Article  CAS  PubMed  Google Scholar 

  31. Schlosser K, Veit JA, Witte S et al (2007) Comparison of total parathyroidectomy without autotransplantation and without thymectomy versus total parathyroidectomy with autotransplantation and with thymectomy for secondary hyperparathyroidism: TOPAR PILOT-Trial. Trials 8:22

    Article  PubMed  PubMed Central  Google Scholar 

  32. Tominaga Y, Numano M, Tanaka Y et al (1997) Surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 13(2):87–96

    Article  CAS  PubMed  Google Scholar 

  33. Neyer U, Hoerandner H, Haid A et al (2002) Total parathyroidectomy with autotransplantation in renal hyperparathyroidism: low recurrence after intra-operative tissue selection. Nephrol Dial Transplant 17(4):625–629

    Article  PubMed  Google Scholar 

  34. Horandner H, Murzl E, Neyer U et al (2000) Focal proliferation in reactive hyperplastic parathyroid tissue in end-stage renal failure—implication for autotransplantation after total parathyroidectomy. Wien Klin Wochenschr 112(8):353–357

    CAS  PubMed  Google Scholar 

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    Authors and Affiliations

    1. Department of Emergency Surgery, The First Affiliated Hospital Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, People’s Republic of China

      D. Xu & L. Hou

    2. Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, People’s Republic of China

      Y. Yin & W. Dai

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    1. D. Xu
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    2. Y. Yin
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    3. L. Hou
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    Correspondence to L. Hou or W. Dai.

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    D. Xu and Y. Yin contributed equally.

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    Xu, D., Yin, Y., Hou, L. et al. Surgical management of secondary hyperparathyroidism: how to effectively reduce recurrence at the time of primary surgery. J Endocrinol Invest 39, 509–514 (2016). https://doi.org/10.1007/s40618-015-0410-8

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    • DOI: https://doi.org/10.1007/s40618-015-0410-8

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