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Parathyroidectomy

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Parathyroid Gland Disorders

Abstract

Successful parathyroidectomy requires an understanding of the embryology and anatomy of the parathyroid glands (PTGs). The superior PTGs have less anatomical variation than the inferior glands. Most parathyroidectomies are performed for primary hyperparathyroidism, the most common cause of which is parathyroid adenoma, accounting for 75–90% of cases. Four-gland hyperplasia can be asymmetric with some glands being very large and others appearing closer to normal in size, shape, and appearance. While, primary hyperparathyroidism occurs when parathyroid hormone (PTH) level is inappropriately elevated in relation to the serum calcium level, secondary hyperparathyroidism occurs when PTH is elevated as the result of another cause, most commonly vitamin D deficiency and renal failure. Tertiary hyperparathyroidism occurs when glands affected by secondary hyperparathyroidism become autonomous and are no longer controlled by the normal feedback mechanisms. This chapter discusses the indications and contraindications of parathyroidectomy, pre-operative care, technical approaches as well as the different methods of parathyroidectomy including bilateral neck dissection, minimally-invasive parathyroidectomy, minimally-invasive radio-guided parathyroidectomy and video-assisted parathyroidectomy. This chapter explores also the potential complications that may be encountered during the procedure.

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References

  1. Slough CM, Dralle H, Machens A, Randolph GW. Diagnosis and treatment of thyroid and parathyroid disorders. In: Bailey BJ, Johnson JT, editors. Head and neck surgery—otolaryngology, vol. 2. 4th ed. Philadelphia: Lippincott Williams and Wilkins; 2006. p. 1647–55.

    Google Scholar 

  2. Norman J, Lopez J, Politz D. Abandoning unilateral parathyroidectomy: why we reversed our position after 15,000 parathyroid operations. J Am Coll Surg. 2012;214(3):260–9.

    Article  PubMed  Google Scholar 

  3. Heath DA. Primary hyperparathyroidism. Clinical presentation and factors influencing clinical management. Endocrinol Metab Clin N Am. 1989;18(3):631–46.

    Article  CAS  Google Scholar 

  4. Carsote M, Paduraru DN, Nica AE, Valea. Parathyroidecotmy: is vitamin D a player for a good outcome? J Med Life. 2016;9:348–52.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Maruani G, Hertig A, Paillard M, Houillier P. Normocalcemic primary hyperparathyroidism: evidence for a generalized target-tissue resistance to parathyroid hormone. J Clin Endocrinol Metab. 2003;88(10):4641–18.

    Article  CAS  PubMed  Google Scholar 

  6. Ozturk FY, Erol S, Canat MM, Karates S, Kauz I, et al. Patients with normocalcemic primary hyper-parathyroidism may have similar metabolic profile as hypercalcemic patients. Endocr J. 2016;63:111–8.

    Article  CAS  Google Scholar 

  7. Souberbielle JC, Cavalier E, Cormier C. How to manage an isolated elevated PTH? Ann Endocrinol (Paris). 2015;76(2):134–41.

    Article  Google Scholar 

  8. NIH conference. Diagnosis and management of asymptomatic primary hyperparathyroidism: consensus development conference statement. Ann Intern Med. 1991;114(7):593–7.

    Google Scholar 

  9. Bilezikian JP, Potts JT Jr, Fuleihan G-H, Kleerekoper M, Neer R, Peacock M. Summary statement from a workshop on asymptomatic primary hype-rparathyroidism: a perspective for the 21st century. J Clin Endocrinol Metab. 2002;87(12):5353–61.

    Article  CAS  PubMed  Google Scholar 

  10. Grant CS, Thompson G, Farley D, van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive para-thyroidectomy: Mayo Clinic experience. Arch Surg. 2005;140(5):472–8.

    Article  PubMed  Google Scholar 

  11. Morris LG, Myssiorek D. When is surgery indicated for asymptomatic primary hyperparathyroidism? Laryngoscope. 2009;119(12):2291–2.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pepe J, Cipriani C, Sonato C, Raimo O, Biamonte F, Minisola S. Cardiovascular manifestations of primary hyperparathyroidism: a narrative review. Eur J Endocrinol. 2017;177(6):R297–308.

    Article  CAS  PubMed  Google Scholar 

  13. Eigelberger MS, Cheah WK, Ituarte PH, Streja L, Duh QY, Clark OH. The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: are they too limited? Ann Surg. 2004;239(4):528–35.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Silverberg SJ, Lewiecki EM, Mosekilde L, Peacock M, Rubin MR. Presentation of asymptomatic primary hyperparathyroidism: proceedings of the third international workshop. J Clin Endocrinol Metab. 2009;94(2):351–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Marx SJ, Stock JL, Attie MF, Downs RW Jr, Gardner DG, Brown EM. Familial hypocalciuric hypercalcemia: recognition among patients referred after unsuccessful parathyroid exploration. Ann Intern Med. 1980;92(3):351–6.

    Article  CAS  PubMed  Google Scholar 

  16. Pelliteri PK, Sofferman RA, Randolph GW. Surgical management of parathyroid disorders. In: Cummings CW, Flint PW, Harker LA, Haughey BH, Richardson MA, Robbins KT, Schuller DE, Thomas JR, editors. Otolaryngology head and neck surgery, vol. 3. 4th ed. Philadelphia: Elsevier Mosby; 1998. p. 120.

    Google Scholar 

  17. Smith JA, Stack BC. Pathophysiology of the parathyroid glands. In: Terris DJ, Gourin CG, editors. Thyroid and parathyroid disease: medical and surgical management. New York: Thieme Medical Publishers, Inc; 2009. p. 184–96.

    Google Scholar 

  18. Greene AB, Butler RS, McIntyre S, Barbosa GF, Mitchell J, Berber E. National trends in parathyroid surgery from 1998 to 2008: a decade of change. J Am Coll Surg. 2009;209(3):332–43.

    Article  PubMed  Google Scholar 

  19. Weber CJ, Vansant J, Alazraki N, Christy J, Watts N, Phillips LS. Value of technetium 99m Sestamibi iodine 123 imaging in reoperative parathyroid surgery. Surgery. 1993;114(6):1011–8.

    CAS  PubMed  Google Scholar 

  20. Terris DJ, Chen N, Seybt MW, Gourin CG, Chin E. Emerging trends in the performance of parathyroid surgery. Laryngoscope. 2007;117(6):1009–12.

    Article  PubMed  Google Scholar 

  21. Powell AC, Alexander HR, Chang R, Marx SJ, Skarulis M, Pingpank JF. Reoperation for parathyroid adenoma: a contemporary experience. Surgery. 2009;146(6):1144–55.

    Article  PubMed  Google Scholar 

  22. Stephen AE, Roth SI, Fardo DW, Finkelstein DM, Randolph GW, Gaz RD. Predictors of an accurate preoperative sestamibi scan for single-gland parathyroid adenomas. Arch Surg. 2007;142(4):381–6.

    Article  PubMed  Google Scholar 

  23. Taillefer R, Boucher Y, Potvin C, Lambert R. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-Sestamibi (double-phase study). J Nucl Med. 1992;33(10):1801–7.

    CAS  PubMed  Google Scholar 

  24. Moka D, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H. Technetium 99m-MIBI-SPECT: a highly sensitive diagnostic tool for localization of parathyroid adenomas. Surgery. 2000;128(1):29–35.

    Article  CAS  PubMed  Google Scholar 

  25. Pata G, Casella C, Besuzio S, Mittempergher F, Salerni B. Clinical appraisal of 99m technetium-sestamibi SPECT/CT compared to conventional SPECT in patients with primary hyperparathyroidism and concomitant nodular goiter. Thyroid. 2010;20(10):1121–7.

    Article  CAS  PubMed  Google Scholar 

  26. Taubman ML, Goldfarb M, Lew JI. Role of SPECT and SPECT/CT in the surgical treatment of primary hyperparathyroidism. Int J Mol Imaging. 2011;2011:141593.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ahuja AT. The thyroid and parathyroids. In: Ahuja AT, Evans R, editors. Practical head and neck ultrasounds. London: Greenwich Medical Media Ltd; 2006. p. 37–64.

    Google Scholar 

  28. Tublin ME, Pryma DA, Yim JH, Ogilvie JB, Mountz JM, Bencherif B. Localization of parathyroid adenomas by sonography and technetium 99mTC Sestamibi single-photon emission computed tomography before minimally invasive parathyroidectomy: are both studies really needed? J Ultrasound Med. 2009;28(2):183–90.

    Article  PubMed  Google Scholar 

  29. Sofferman RA, Nathan MH, Fairbank JT, Foster RS Jr, Krag DN. Preoperative technetium Tc 99m sestamibi imaging. Paving the way to minimal-access parathyroid surgery. Arch Otolaryngol Head Neck Surg. 1996;122(4):369–74.

    Article  CAS  PubMed  Google Scholar 

  30. Harari A, Zarnegar R, Lee J, Kazam E, Inabnet WB 3rd, Fahey TJ 3rd. Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative Sestamibi scanning. Surgery. 2008;144(6):970–6.

    Article  PubMed  Google Scholar 

  31. Chen H, Sokoll LJ, Udelsman R. Outpatient minimally invasive parathyroidectomy: a combination of Sestamibi-SPECT localization, cervical block anesthesia, and intra-operative parathyroid hormone assay. Surgery. 1999;126(6):1016–21. discussion 1021–22

    Article  CAS  PubMed  Google Scholar 

  32. Proctor MD, Sofferman RA. Intra-operative parathyroid hormone testing: what have we learned? Laryngoscope. 2003;113(4):706–14.

    Article  PubMed  Google Scholar 

  33. Norman J, Politz D. Prospective study in 3,000 consecutive parathyroid operations demonstrates 18 objective factors that influence the decision for unilateral versus bilateral surgical approach. J Am Coll Surg. 2010;211(2):244–9.

    Article  PubMed  Google Scholar 

  34. Siperstein A, Berber E, Barbosa GF, Tsinberg M, Greene AB, Mitchell J. Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, Sestamibi, and intra-operative parathyroid hormone: analysis of 1158 cases. Ann Surg. 2008;248(3):420–8.

    Article  PubMed  Google Scholar 

  35. Lew JI, Irvin GL 3rd. Focused parathyroidectomy guided by intra-operative parathormone monitoring does not miss multiglandular disease in patients with sporadic primary hyperparathyroidism: a 10-year outcome. Surgery. 2009;146(6):1021–7.

    Article  PubMed  Google Scholar 

  36. Sokoll LJ, Remaley AT, Sena SF, Wians FH Jr, Wu J, Libutti SK, et al. Intraoperative parathyroid hormone. In: Laboratory medicine practice guidelines: evidence-based practice for point-of-care testing. Washington, DC: National Academy of Clinical Biochemistry; 2006. p. 105–19.

    Google Scholar 

  37. Kao PC, van Heerden JA, Taylor RL. Intraoperative monitoring of parathyroid procedures by a 15-minute parathyroid hormone immunochemiluminometric assay. Mayo Clin Proc. 1994;69(6):532–7.

    Article  CAS  PubMed  Google Scholar 

  38. Sofferman RA. Advance techniques in parathyroid surgery. In: Terris DJ, Gourin CG, editors. Thyroid and parathyroid disease. New York: Thieme Medical Publishers, Inc; 2009. p. 234–43.

    Google Scholar 

  39. Norman J, Chheda H, Farrell C. Minimally invasive parathyroidectomy for primary hyperparathyroidism: decreasing operative time and potential complications while improving cosmetic results. Am Surg. 1998;64(5):391–5.

    CAS  PubMed  Google Scholar 

  40. Murphy C, Norman J. The 20% rule: a simple, instantaneous radioactivity measurement defines cure and allows elimination of frozen sections and hormone assays during parathyroidectomy. Surgery. 1999;126(6):1023–8.

    Article  CAS  PubMed  Google Scholar 

  41. Lew JI, Rivera M, Irvin GL 3rd, Solorzano CC. Operative failure in the era of focused parathyroidectomy: a contemporary series of 845 patients. Arch Surg. 2010;145(7):628–33.

    Article  CAS  PubMed  Google Scholar 

  42. Schulte KM, Talat N, Miell J, Moniz C, Sinha P, Diaz-Cano S. Lymph node involvement and surgical approach in parathyroid cancer. World J Surg. 2010;34(11):2611–20.

    Article  PubMed  Google Scholar 

  43. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg. 2002;236(5):543–51.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg. 2002;235(5):665–70.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Peel JK, Melk AL. Same-day discharge after unilateral parathyroidectomy is safe. Can J Surg. 2016;59(4):242–6.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Carneiro DM, Solorzano CC, Irvin GL 3rd. Recurrent disease after limited parathyroidectomy for sporadic primary hyperparathyroidism. J Am Coll Surg. 2004;199(6):849–53.

    Article  PubMed  Google Scholar 

  47. Grant CS, Thompson G, Farley D, Van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg. 2005;140(5):472–9.

    Article  PubMed  Google Scholar 

  48. Mehrabibahar M, Mousavi Z, Sudeghi R, Nouri M, Asadi M, et al. Feasibility and safety of minimally invasive radio-guided parathyroidectomy using very low intra-operative dose of Tc-99m MIBI. Int J Surg. 2017;39:229–33.

    Article  PubMed  Google Scholar 

  49. Barczyński M, Papier A, Kenig J, Nawrot I. A retrospective case-controlled study of video-assisted versus open minimally invasive parathyroidectomy. Wideochir Inne Tech Maloinwazyjne. 2014;9:537–47.

    PubMed  PubMed Central  Google Scholar 

  50. Barczynski M, Cichon S, Konturek A, Cichon W. Minimally invasive video-assisted parathyroidectomy versus open minimally invasive parathyroidectomy for a solitary parathyroid adenoma: a prospective, randomized, blinded trial. World J Surg. 2006;30(5):721–31.

    Article  PubMed  Google Scholar 

  51. Miccoli P, Berti P. Minimally invasive parathyroid surgery. Best Pract Res Clin Endocrinol Metab. 2001;15(2):139–47.

    Article  CAS  PubMed  Google Scholar 

  52. Bakkar S, Biricotti M, Fregoli L, Matteucci V, Papini P, Pagliaro S, et al. Minimally invasive video-assisted parathyroidectomy; a detailed illustration and highlighting an additional potential advantage over other targeted parathyroid surgeries. Surg Curr Res. 2016;6:278. https://doi.org/10.4172/2161-1076.1000278.

    Article  Google Scholar 

  53. Tezelman S, Shen W, Shaver JK, Siperstein AE, Duh QY, Klein H, et al. Double parathyroid adenomas. Clinical and biochemical characteristics before and after parathyroidectomy. Ann Surg. 1993;218:300–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Goodman A, Politz D, Lopez J, Norman J. Intrathyroid parathyroid adenoma: incidence and location—the case against thyroid lobectomy. Otolaryngol Head Neck Surg. 2011;144:867–71.

    Article  PubMed  Google Scholar 

  55. Wei CH, Harari A. Parathyroid carcinoma: update and guidelines for management. Curr Treat Options in Oncol. 2012;13:11–23.

    Article  Google Scholar 

  56. Henry JF, Defechereux T, Gramatica L, de Boissezon C. Minimally invasive videoscopic parathyroidectomy by lateral approach. Langenbeck’s Arch Surg. 1999;384:298–301.

    Article  CAS  Google Scholar 

  57. Alesina PF, Singaporewalla RM, Walz MK. Video-assisted bilateral neck exploration in patients with primary hyperparathyroidism and failed localization studies. World J Surg. 2010;34:2344–9.

    Article  PubMed  Google Scholar 

  58. Miccoli P, Materazzi G, Bonari G, Donatini G, Berti P. Minimally-invasive video-assisted parathyroidectomy. Oper Tech Otolaryngol. 2008;19:22–5.

    Article  Google Scholar 

  59. Bakkar S, Materazzi G, Biricotti M, De Napoli L, Conte M. Minimally invasive video-assisted thyroidectomy (MIVAT) from A to Z. Surg Today. 2016;46:255–9.

    Article  PubMed  Google Scholar 

  60. Alesina PF, Hinrichs J, Kribben A, Walz MK. Minimally invasive videoassisted parathyroidectomy (MIVAP) for secondary hyperparathyroidism: report of initial experience. Am J Surg. 2010;199:851–5.

    Article  PubMed  Google Scholar 

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  1. Faculty of Medicine, University of Alexandria, Alexandria, Egypt

    Mahmoud F. Sakr

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Sakr, M.F. (2022). Parathyroidectomy. In: Parathyroid Gland Disorders. Springer, Cham. https://doi.org/10.1007/978-3-031-07418-9_18

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  • DOI: https://doi.org/10.1007/978-3-031-07418-9_18

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