MULTIGLANDULAR PARATHYROID GLAND DISEASE: AN INCIDENTAL DISCOVERY IN NORMOCALCEMIC PATIENTS DURING THYROID SURGERY

Overview

Journal Acta Endocrinol (Buchar)

Specialty Endocrinology

Date 2019 Jun 1

PMID 31149199

Citations 3

Authors

S M Cherenko

A Dinets

G V Bandura

S A Sheptuha

O S Larin

Affiliations

Soon will be listed here.

Abstract

Context: Several enlarged parathyroid glands could be found during thyroid surgery in normocalcemic patients without evidence of primary or secondary hyperparathyroidism, indicating multiglandular parathyroid gland disease (MGD).

Objective: Clinical role of various levels of serum ionized calcium (Ca) in patients diagnosed with incidental MGD during thyroid surgery remains controversial. The aim of the study was to evaluate the features of PHPT and the clinical role of serum Ca in normocalcemic patients diagnosed with incidental MGD.

Study Design: A prospective study of patients with normal preoperative Ca to be operated on for thyroid diseases in 2010-2013 and diagnosed with MGD during thyroid surgery.

Methods: An analysis of clinical data from 3,561 patients to be surgically treated for thyroid diseases revealed 219 (6%) patients with MGD and normal serum Ca. Further data analyses showed patients with MGD and high normal (≥1.25 - 1.3 mmol/L) serum Ca (n = 89) and with moderate-low (1.0 - 1.24 mmol/L) serum Ca (n = 130).

Results: Primary hyperparathyroidism was diagnosed intra- and post-operatively in 48 (54%) patients with high-normal serum Ca and in 2 (2%) patients with moderate-low serum Ca (p<0.0001). Parathyroid hormone, serum Ca as well as urine calcium excretion were elevated in 2 (2%) patients with moderate-low serum Ca and in 18 (20%) patients with high-normal Ca at follow-up (p<0.0001).

Conclusion: Serum Ca level within the normal range, but higher than 1.25 mmol/L (high-normal) is associated with primary hyperparathyroidism, which should be considered in patients with visually diagnosed MGD, but without clinical symptoms of hyperparathyroidism.

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References

Wahl R, Hentschel F, Vorlander C, Schabram J . Primary hyperparathyroidism--early diagnosis in patients referred for thyroid surgery. Langenbecks Arch Surg. 2001; 385(8):515-20. DOI: 10.1007/s004230000171. View

Gauger P, Agarwal G, England B, Delbridge L, Matz K, WILKINSON M . Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: a 2-institution experience. Surgery. 2001; 130(6):1005-10. DOI: 10.1067/msy.2001.118385. View

Denizot A, Dadoun F, Alliot P, Argeme M . Screening for primary hyperparathyroidism before thyroid surgery: A prospective study. Surgery. 2002; 131(3):264-9. DOI: 10.1067/msy.2002.121379. View

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):4641-8. DOI: 10.1210/jc.2002-021404. View

Anton R, Wheeler T . Frozen section of thyroid and parathyroid specimens. Arch Pathol Lab Med. 2005; 129(12):1575-84. DOI: 10.5858/2005-129-1575-FSOTAP. View

Lokey J, Palmer R, Macfie J . Unexpected findings during thyroid surgery in a regional community hospital: a 5-year experience of 738 consecutive cases. Am Surg. 2005; 71(11):911-3. View

Goretzki P, Dotzenrath C, Roeher H . Management of primary hyperparathyroidism caused by multiple gland disease. World J Surg. 1991; 15(6):693-7. DOI: 10.1007/BF01665302. View

Beyer T, Chen E, Nilubol N, Prinz R, Solorzano C . Short-term outcomes of parathyroidectomy in patients with or without 25-hydroxy vitamin D insufficiency. J Surg Res. 2007; 143(1):145-50. DOI: 10.1016/j.jss.2007.06.009. View

Niedzwiecki S, Kuzdak K, Kaczka K, Pomorski L . Normocalcemic, subclinical, asymptomatic primary hyperparathyroidism in patients with goiter or papillary thyroid cancer--preliminary report. Normocalcemic primary hyperparathyroidism and thyroid pathology. Wiad Lek. 2007; 60(5-6):228-30. View

10.

Abboud B, Sleilaty G, Braidy C, Ghorra C, Abadjian G, Tohme C . Enlarged parathyroid glands discovered in normocalcemic patients during thyroid surgery. Am J Surg. 2007; 195(1):30-3. DOI: 10.1016/j.amjsurg.2007.01.033. View

11.

Cayo A, Sippel R, Schaefer S, Chen H . Utility of intraoperative PTH for primary hyperparathyroidism due to multigland disease. Ann Surg Oncol. 2009; 16(12):3450-4. DOI: 10.1245/s10434-009-0699-7. View

12.

Cook M, Pitt S, Schaefer S, Sippel R, Chen H . A rising ioPTH level immediately after parathyroid resection: are additional hyperfunctioning glands always present? An application of the Wisconsin Criteria. Ann Surg. 2010; 251(6):1127-30. PMC: 4254909. DOI: 10.1097/SLA.0b013e3181d3d264. View

13.

Nagar S, Reid D, Czako P, Long G, Shanley C . Outcomes analysis of intraoperative adjuncts during minimally invasive parathyroidectomy for primary hyperparathyroidism. Am J Surg. 2011; 203(2):177-81. DOI: 10.1016/j.amjsurg.2010.10.015. View

14.

Boehm B, Rosinger S, Belyi D, Dietrich J . The parathyroid as a target for radiation damage. N Engl J Med. 2011; 365(7):676-8. DOI: 10.1056/NEJMc1104982. View

15.

Helme S, Lulsegged A, Sinha P . Incidental Parathyroid Disease during Thyroid Surgery: Should We Remove Them?. ISRN Surg. 2011; 2011:962186. PMC: 3200303. DOI: 10.5402/2011/962186. View

16.

Dinets A, Hulchiy M, Sofiadis A, Ghaderi M, Hoog A, Larsson C . Clinical, genetic, and immunohistochemical characterization of 70 Ukrainian adult cases with post-Chornobyl papillary thyroid carcinoma. Eur J Endocrinol. 2012; 166(6):1049-60. PMC: 3361791. DOI: 10.1530/EJE-12-0144. View

17.

Sheahan P, Mehanna R, Basheeth N, Murphy M . Is systematic identification of all four parathyroid glands necessary during total thyroidectomy?: a prospective study. Laryngoscope. 2013; 123(9):2324-8. DOI: 10.1002/lary.23954. View

18.

Schneider D, Burke J, Ojomo K, Clark N, Mazeh H, Sippel R . Multigland disease and slower decline in intraoperative PTH characterize mild primary hyperparathyroidism. Ann Surg Oncol. 2013; 20(13):4205-11. PMC: 4250040. DOI: 10.1245/s10434-013-3190-4. View

19.

Zawawi F, Mlynarek A, Cantor A, Varshney R, Black M, Hier M . Intraoperative parathyroid hormone level in parathyroidectomy: which patients benefit from it?. J Otolaryngol Head Neck Surg. 2013; 42:56. PMC: 3878236. DOI: 10.1186/1916-0216-42-56. View

20.

Segiet O, Deska M, Michalski M, Gawrychowski J, Wojnicz R . Molecular profiling in primary hyperparathyroidism. Head Neck. 2014; 37(2):299-307. DOI: 10.1002/hed.23656. View