Emerging Trends in the Performance of Parathyroid Surgery

Terris, David J.; Chen, Nan; Seybt, Melanie W.; Gourin, Christine G.; Chin, Edward

doi:10.1097/mlg.0b013e3180485716

Cited by 20 publications

(24 citation statements)

References 12 publications

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“…In this patient scan was done with 99m Tc MIBI. Although a comprehensive 4-gland parathyroid exploration has traditionally been the standard, operating time and hospital stay can be decreased by performing targeted parathyroid surgery [10]. Proponents of 1-gland or unilateral parathyroid exploration maintain that this approach allows smaller incisions, regional anaesthesia, and sameday hospital discharge and that it may also reduce the risk of laryngeal nerve injury and postoperative hypocalcaemia.…”

Section: Discussionmentioning

confidence: 99%

Parathyroid Adenoma In a Young Male with Multiple Fractures and Varied Clinical Features

Murthy

Srihari

Narayana

2012

Indian J Otolaryngol Head Neck Surg

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Primary hyperparathyroidism is due to parathyroid adenoma (80-85%), hyperplasia (10-15%), carcinoma (2-3%) of cases. The most common presentation is asymptomatic hypercalcemia. Multiple pathological fractures, nephrocalcinosis as a presenting feature of primary hyperparathyroidism due to parathyroid adenoma is extremely rare at the age of 19 years. A case of parathyroid adenoma with multiple fractures of left femur, renal calculi, nephrocalcinosis, weight loss, constipation, dyspepsia abdominal pain was presented. The case was investigated completely with biochemical investigations, X-ray of forearm bones and femur, ultrasonography of neck and abdomen, CT scan of neck and abdomen, MRI scan, Scintigraphy of the neck. Right inferior parathyroid adenoma was diagnosed and confirmed by histopathological examination after excision. The post operative serum calcium levels became normal.Keywords Parathyroid adenoma Á Ultrasonography Á Scintigraphy Case ReportRohit 19 years old boy presented with supracondylar fracture of femur on trivial fall, abdominal pain, dyspepsia, pain during micturition. The previous history showed fracture neck of femur on trivial fall 2 months before. On examination showed swelling in the right lower lobe of thyroid region, moving with deglutition. Serum calcium (12.5 mg/dl), parathyroid hormone (817 pg/ml), urinary calcium (438 mg/24 h of urine) levels were elevated. X-ray of forearm bones showing lytic expansile lesion of right 5th metacarpal bone involving the metadiaphysial region with endosteal scalloping. Ultrasonography of neck shows solid cystic lesion inferior to right thyroid gland ( Fig. 1) with increased vascularity. Ultrasonography of abdomen showed multiple calcifications involving both kidneys in upper, middle and lower calyces suggesting nephrocalcinosis. CT SCAN of neck plain and contrast shows 3.4 9 1.7 cm cystic lesion with enhancing solid component noted inferior to right thyroid gland. MRI scan of the hip joints showed multiple cystic lesions of right ilium, left ilium, right femoral neck and upper shaft with pathological fracture of left femur neck. MRI scan of left knee joint showed expansion of the lower end of the femur with multiple cystic lesions and pathological fracture at metadiaphysial region (Fig. 2) with synovial effusion.Parathyroid scintigraphy and SPECT CT study was done. 15 mci of 99m Tc MIBI was injected intravenously. Early static images (15 min), delayed static images (40 min) and SPECT CT (20 min) were acquired. Early static image showed diffuse tracer activity of both lobes of thyroid gland with more intense activity at right lower lobe. Delayed static scans showed intense tracer activity at the right lobe of the lower aspect of thyroid gland with wash out of the tracer from the remaining part of the gland. SPECT CT study confirmed 3.88 9 1.7 cm soft tissue density nodule at the lower pole of right lobe of thyroid gland.Under a definitive diagnosis of parathyroid adenoma, targeted excision of the enlarged right inferior parathyroid adenoma was ...

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Section: Discussionmentioning

confidence: 99%

Parathyroid Adenoma In a Young Male with Multiple Fractures and Varied Clinical Features

Murthy

Srihari

Narayana

2012

Indian J Otolaryngol Head Neck Surg

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“…In two studies published in the otolaryngology literature, researchers have proposed that since at least 1996, there has been a trend toward parathyroidectomies and thyroidectomies being done by otolaryngologists and not general surgeons (3, 4). Both studies evaluated the increasing number of endocrine procedures done by chief residents in both fields as well as the growing proportion of articles on thyroid and parathyroid surgery being authored by otolaryngologists as proof of this claim.…”

Section: Discussionmentioning

confidence: 99%

“…Both studies evaluated the increasing number of endocrine procedures done by chief residents in both fields as well as the growing proportion of articles on thyroid and parathyroid surgery being authored by otolaryngologists as proof of this claim. In the thyroid study, graduating otolaryngology residents are shown to have participated in more thyroidectomies on average than general surgery residents since 1995 with a growing gap in the number of cases up to 2004 (3). In our study we found similar results for thyroidectomy case volume, with otolaryngology residents in the role of surgeon junior and surgeon chief performing a significantly larger number of procedures than general surgery residents.…”

Section: Discussionmentioning

confidence: 99%

“…A large proportion of these procedures are being done by high-volume endocrine surgeons, but many are still being performed by general surgeons who perform only a few thyroidectomies and parathyroidectomies each year (1, 2). Over the last few years there has also been an increase in the percentage of thyroid and parathyroid procedures being done by otolaryngologists (3, 4, 5). Given the projected growth in endocrine procedures, more general surgeons will be needed that are capable of performing these procedures.…”

Section: Introductionmentioning

confidence: 99%

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Training our future endocrine surgeons: A look at the endocrine surgery operative experience of U.S. surgical residents

Zarebczan

McDonald

Rajamanickam

et al. 2010

Surgery

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“…The current guidelines, summarized in this review, are the consensus recommendations of 10 international endocrine societies, including two endocrine surgical societies. This review will summarize the most recent guidelines from the endocrinology literature for surgeons, a group that includes otolaryngologists–head and neck surgeons, who are participating in an increasing share of patient care and research related to parathyroid disease 3…”

Section: Introductionmentioning

confidence: 99%