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World Journal of Surgery

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01-03-2016 | Original Scientific Report

Location Frequency of Missed Parathyroid Glands After Parathyroidectomy in Patients with Persistent or Recurrent Secondary Hyperparathyroidism

Authors: Manabu Okada, Yoshihiro Tominaga, Takayuki Yamamoto, Takahisa Hiramitsu, Shunji Narumi, Yoshihiko Watarai

Published in: World Journal of Surgery | Issue 3/2016

Abstract

Background

Reoperative parathyroidectomy (RPTX) because parathyroid glands have been missed is frequently required in patients with secondary hyperparathyroidism (SHPT). The usual locations of these missed glands in patients with SHPT are yet to be fully elucidated.

Methods

We retrospectively investigated the locations of missed glands in 165 patients who underwent RPTX for persistent or recurrent SHPT at our institution from August 1982 to July 2014. At our institution, total parathyroidectomy with forearm autograft is the routine operative procedure for SHPT. We also routinely resect the thymic tongue.

Results

Of 165 patients, 82 underwent initial parathyroidectomy at our institution (Group A), and the remaining 83 underwent initial parathyroidectomy at other institutions (Group B). A total of 239 parathyroid glands were resected (Group A, 93; Group B, 146). Missed glands were most commonly located in the mediastinum (Group A, 22/93) and the thymic tongue (Group B, 31/146).

Conclusions

In patients with persistent or recurrent SHPT, ectopic parathyroid glands are frequently located in the mediastinum and thymic tongue. Therefore, resecting the thymic tongue during the initial operation may reduce the need for RPTX.

Block GA, Klassen PS, Lazarus JM et al (2004) Mineral metabolism, mortality, and morbidity in maintenance hemodialysis patients. J Am Soc Nephrol 15:2208–2218CrossRefPubMed

Stevens LA, Djurdjev O, Cardew S et al (2004) Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am Soc Nephrol 15:770–779CrossRefPubMed

Block GA, Shearon EH, Levin NW et al (1998) Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney 31:607–617CrossRef

Block GA, Port FK (2000) Re-evaluation of risks associated with hyperphosphatemia and hyperparathyroidism in dialysis patients: recommendations for a change in management. Am J Kidney 35:1226–1237CrossRef

Goodman WG (2002) Calcimimetic agents and secondary hyperparathyroidism: treatment and prevention. Nephrol Dial Transplant 17:204–207CrossRefPubMed

Cunningham J, Danese M, Olson K et al (2005) Effect of the calcimimetic cinacalcet HCl on cardiovascular disease, fracture, and health-related quality of life in secondary hyperparathyroidism. Kidney Int 68:1793–1800CrossRefPubMed

Tominaga Y, Kakuta T, Yasunaga C, et al Evaluation of parathyroidectomy for secondary and tertiary hyperparathyroidism in Japan: by the Parathyroid Surgeons’ Society of Japan. Ther Apher Dial (forthcoming)

Ballinger AE, Palmer SC, Nistor I et al (2014) Calcimimetics for secondary hyperparathyroidism in chronic kidney disease patients. Cochrane Database Syst Rev 12:CD006254. doi:10.1002/14651858.CD006254 PubMed

Sharma A, Marshall TS, Khan SS et al (2014) Cost effectiveness of paricalcitol versus cinacalcet with low-dose vitamin D for management of secondary hyperparathyroidism in haemodialysis patients in the USA. Clin Drug Investig 34:107–115. doi:10.1007/s40261-013-0151-4 PubMedCentralCrossRefPubMed

10.

Ghani A, Baxter P (2012) Surgical parathyroidectomy versus cinacalcet therapy: in the management of secondary hyperparathyroidism. Otolaryngol Head Neck Surg 146:220–225. doi:10.1177/0194599811428272 CrossRefPubMed

11.

Foundation Kidney (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am. J kid Dis 42:S1–S140

12.

Guideline working Group (2008) Japanese Society for Dialysis Therapy: clinical practice guideline for management of secondary hyperparathyroidism in chronic dialysis patients. Ther Apher Dial 12:514–525. doi:10.1111/j.1744-9987.2008.00648.x CrossRef

13.

Matsuoka S, Tominaga Y, Sato T et al (2007) Quick-intraoperative bio-intact PTH assay at parathyroidectomy for secondary hyperparathyroidism. World J Surg 31:824–831CrossRefPubMed

14.

Hiramitsu T, Tominaga Y, Okada M et al (2015) A retrospective study of the impact of intraoperative intact parathyroid hormone monitoring during total parathyroidectomy for secondary hyperparathyroidism. Medicine 94(29):e1213. doi:10.1097/MD.0000000000001213 PubMedCentralCrossRefPubMed

15.

Tominaga Y, Matsuoka S, Uno N et al (2010) Removal of autografted parathyroid tissue for recurrent renal hyperparathyroidism in hemodialysis patients. World J Surg 34:1312–1317CrossRefPubMed

16.

Numano M, Tominaga Y, Uchida K et al (1998) Surgical significance of supernumerary parathyroid glands in renal hyperparathyroidism. World J Surg 22:1098–1102CrossRefPubMed

17.

Pattou FN, Pellissier LC, Neol C et al (2000) Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism. World J Surg 24:1330–1334CrossRefPubMed

18.

Akerstrom G, Malmaeus J, Bergstrom R (1984) Surgical anatomy of human parathyroid glands. Surgery 95:14–21PubMed

19.

Tominaga Y (2013) Surgical management of secondary and tertiary hyperparathyroidism. In: Gregory WR (ed) Surgery of the thyroid and parathyroid glands, 2nd edn. Elsevier Saunders, Philadelphia, pp 639–647

20.

Uno N, Tominaga Y, Matsuoka S et al (2008) Incidence of parathyroid glands located in thymus in patients with renal hyperparathyroidism. World J Surg 32:2516–2519CrossRefPubMed

21.

Tominaga Y, Katayama A, Sato T et al (2003) Re-operation is frequently required when parathyroid glands remain after initial parathyroidectomy for advanced secondary hyperparathyroidism in uraemic patients. Nephrol Dial Transplant 18(Suppl 3):iii65–iii70PubMed

22.

Elliot JM, Raymon HG, Quan-Yan D (2013) Guide to preoperative parathyroid localization testing. In: Gregory WR (ed) Surgery of the thyroid and parathyroid glands, 2nd edn. Elsevier Saunders, Philadelphia, pp 539–545

Title: Location Frequency of Missed Parathyroid Glands After Parathyroidectomy in Patients with Persistent or Recurrent Secondary Hyperparathyroidism
Authors: Manabu Okada
Yoshihiro Tominaga
Takayuki Yamamoto
Takahisa Hiramitsu
Shunji Narumi
Yoshihiko Watarai
Publication date: 01-03-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 3/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-3312-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Location Frequency of Missed Parathyroid Glands After Parathyroidectomy in Patients with Persistent or Recurrent Secondary Hyperparathyroidism

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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