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Is focused parathyroidectomy appropriate for patients with primary hyperparathyroidism?

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: The aim of this study was to determine whether focused or complete parathyroidectomy was more appropriate and to compare follow-up data in primary hyperparathyroidism (PHPT).

Methods: We retrospectively analyzed 225 operations for PHPT at Yonsei University Health System between 2000 and 2012. After excluding 93 patients, the remaining 132 were divided into 2 groups: those who underwent focused parathyroidectomy (FP) and those who underwent conventional parathyroidectomy (CP). We compared clinicopathological features; preoperative calcium, parathyroid hormone (PTH), phosphorus, vitamin D, 24-hour urine calcium, and alkaline phosphatase levels; postoperative calcium and PTH levels; pathologic diagnosis; multiplicity; and results of a localization study between the 2 groups.

Results: There was no significant difference in the rates of development of postoperative persistent hyperparathyroidism (1/122 FP patients and 1/10 CP patients) between the 2 groups due to a technical reason (FP 0.8% vs. CP 10.0%, P = 0.146). Multiglandular disease (MGD) was uncommon in all cases (6 of 132, 4.5%). All MGD cases were diagnosed using a preoperative localization study. Sestamibi scan and ultrasonography sensitivity were 94.2% and 90.2%, respectively.

Conclusion: We suggest that FP is appropriate in PHPT, except in cases of MGD if detected before the operation using preoperative imaging. Knowledge of hereditary PHPT and improved preoperative localization studies, such as high-resolution ultrasonography, contributed to the decision to perform FP rather than CP in all cases of unilateral results of the localizing study.

No MeSH data available.


Related in: MedlinePlus

Characteristics of the cases excluded. PHPT, primary hyperparathyroidism; CRF, chronic renal failure; MEN, multiple endocrine neoplasia; HPT, hyperparathyroidism; MIBI, sestamibi; USG, ultrasonography.
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Figure 1: Characteristics of the cases excluded. PHPT, primary hyperparathyroidism; CRF, chronic renal failure; MEN, multiple endocrine neoplasia; HPT, hyperparathyroidism; MIBI, sestamibi; USG, ultrasonography.

Mentions: This study was approved by the Yonsei University Institutional Review Board (approval number: 4-2014-0015). The need for informed consent was waived because of the retrospective nature of the study. We retrospectively analyzed 225 operations for PHPT at Yonsei University Health System between 2000 and 2012. Ninety-three cases met the exclusion criteria, and 30 cases were excluded owing to multiple endocrine neoplasm, familial isolated hyperparathyroidism, pending chronic renal failure, parathyroid cyst, or parathyroid carcinoma. Furthermore, 51 cases were excluded owing to concomitant thyroid disease requiring thyroidectomy, and 12 cases were excluded owing to an incomplete preoperative study (Fig. 1). All patients underwent preoperative ultrasonography (USG) and a MIBI scan, and all pathology-based diagnoses were confirmed histopathologically after the operation. We did not use intraoperative parathyroid hormone (PTH) monitoring. Instead, we assessed postoperative PTH levels within 2 hours after the operation. A total of 132 patients were divided into 2 groups according to the operation method: those who underwent FP (n = 122) and those who underwent CP (n = 10). The FP group included minimally invasive radio-guided parathyroidectomy and endoscopic parathyroidectomy. We compared the clinicopathological features, including symptoms and signs; preoperative calcium, PTH, phosphorus, vitamin D, 24-hour urine calcium, and ALP levels; postoperative calcium and PTH levels; pathologic diagnosis; multiplicity; and results of the localization study. Recurrence was defined as elevated calcium and PTH occurring after 6 months postoperatively. Persistence was defined as elevated calcium and PTH within 6 months postoperatively [20].


Is focused parathyroidectomy appropriate for patients with primary hyperparathyroidism?
Characteristics of the cases excluded. PHPT, primary hyperparathyroidism; CRF, chronic renal failure; MEN, multiple endocrine neoplasia; HPT, hyperparathyroidism; MIBI, sestamibi; USG, ultrasonography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016607&req=5

Figure 1: Characteristics of the cases excluded. PHPT, primary hyperparathyroidism; CRF, chronic renal failure; MEN, multiple endocrine neoplasia; HPT, hyperparathyroidism; MIBI, sestamibi; USG, ultrasonography.
Mentions: This study was approved by the Yonsei University Institutional Review Board (approval number: 4-2014-0015). The need for informed consent was waived because of the retrospective nature of the study. We retrospectively analyzed 225 operations for PHPT at Yonsei University Health System between 2000 and 2012. Ninety-three cases met the exclusion criteria, and 30 cases were excluded owing to multiple endocrine neoplasm, familial isolated hyperparathyroidism, pending chronic renal failure, parathyroid cyst, or parathyroid carcinoma. Furthermore, 51 cases were excluded owing to concomitant thyroid disease requiring thyroidectomy, and 12 cases were excluded owing to an incomplete preoperative study (Fig. 1). All patients underwent preoperative ultrasonography (USG) and a MIBI scan, and all pathology-based diagnoses were confirmed histopathologically after the operation. We did not use intraoperative parathyroid hormone (PTH) monitoring. Instead, we assessed postoperative PTH levels within 2 hours after the operation. A total of 132 patients were divided into 2 groups according to the operation method: those who underwent FP (n = 122) and those who underwent CP (n = 10). The FP group included minimally invasive radio-guided parathyroidectomy and endoscopic parathyroidectomy. We compared the clinicopathological features, including symptoms and signs; preoperative calcium, PTH, phosphorus, vitamin D, 24-hour urine calcium, and ALP levels; postoperative calcium and PTH levels; pathologic diagnosis; multiplicity; and results of the localization study. Recurrence was defined as elevated calcium and PTH occurring after 6 months postoperatively. Persistence was defined as elevated calcium and PTH within 6 months postoperatively [20].

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: The aim of this study was to determine whether focused or complete parathyroidectomy was more appropriate and to compare follow-up data in primary hyperparathyroidism (PHPT).

Methods: We retrospectively analyzed 225 operations for PHPT at Yonsei University Health System between 2000 and 2012. After excluding 93 patients, the remaining 132 were divided into 2 groups: those who underwent focused parathyroidectomy (FP) and those who underwent conventional parathyroidectomy (CP). We compared clinicopathological features; preoperative calcium, parathyroid hormone (PTH), phosphorus, vitamin D, 24-hour urine calcium, and alkaline phosphatase levels; postoperative calcium and PTH levels; pathologic diagnosis; multiplicity; and results of a localization study between the 2 groups.

Results: There was no significant difference in the rates of development of postoperative persistent hyperparathyroidism (1/122 FP patients and 1/10 CP patients) between the 2 groups due to a technical reason (FP 0.8% vs. CP 10.0%, P = 0.146). Multiglandular disease (MGD) was uncommon in all cases (6 of 132, 4.5%). All MGD cases were diagnosed using a preoperative localization study. Sestamibi scan and ultrasonography sensitivity were 94.2% and 90.2%, respectively.

Conclusion: We suggest that FP is appropriate in PHPT, except in cases of MGD if detected before the operation using preoperative imaging. Knowledge of hereditary PHPT and improved preoperative localization studies, such as high-resolution ultrasonography, contributed to the decision to perform FP rather than CP in all cases of unilateral results of the localizing study.

No MeSH data available.


Related in: MedlinePlus