Frequency of Ectopic and Supernumerary Intrathymic Parathyroid Glands in Patients with Renal Hyperparathyroidism: Analysis of 461 Patients Undergoing Initial Parathyroidectomy with Bilateral Cervical Thymectomy

Schneider, R.; Waldmann, Jens; Ramaswamy, Annette; Fernández, Emilio Domínguez; Bartsch, Detlef K.; Schlosser, Katja

doi:10.1007/s00268-011-1079-6

Cited by 72 publications

(51 citation statements)

References 37 publications

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“…The absence of PTH is associated with the risk of adynamic bone disease, especially in young patients who could receive a transplant. The presence of PTH following surgery suggests that some residual tissue remains and supports the practice of routine thymectomy (25). This may explain the low iPTH levels that we observed in follow-up.…”

Section: Discussionsupporting

confidence: 69%

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Sakman¹,

Parsak²,

Balal³

et al. 2014

Balkan Med J

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Secondary hyperparathyroidism (sHPT) is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events (1). Parathyroidectomy (PTX) is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years (2, 3).When medical treatment fails, subtotal parathyroidectomy (subtotal PTX) with a cervical remnant and total parathyroidectomy with autotransplantation (total PTX+AT) are the standard procedures, although both are associated with high recurrence rates (4-7). A considerable quantity of functioning parathyroid tissue is left after each of these operations in order to prevent possible hypoparathyroidism and the need for longBackground: Secondary hyperparathyroidism is a common acquired disorder seen in chronic renal failure. It may result in potentially serious complications including metabolic bone diseases, severe atherosclerosis and undesirable cardiovascular events. Parathyroidectomy is required in about 20% of patients after 3-10 years of dialysis and in up to 40% after 20 years. Aims: The aim of the current study was to evaluate the short-term and long-term outcomes of patients with secondary hyperparathyroidism who had undergone total parathyroidectomy with autotransplantation and thymectomy or subtotal parathyroidectomy with thymectomy by the same surgical team during the study period. Study Design: Retrospective comparative study. Methods: Clinical data of 50 patients who underwent parathyroid surgery for secondary hyperparathyroidism between 2003 and 2011 were reviewed retrospectively. Patients were divided into two subgroups of total parathyroidectomy with autotransplantation or subtotal parathyroidectomy. Thymectomy was routinely performed for both groups. Short term outcome parameters included intact parathyroid hormone, ionized calcium and alkaline phosphatase levels. Bone pain, bone fractures, persistent or recurrent disease were included in long term outcome parameters. Results: The mean duration of dialysis was eight years. The mean ionized calcium levels dropped significantly in the total parathyroidectomy with autotransplantation group (p=0.016). No serious postoperative complications were observed. Postoperative intravenous calcium supplementation was required in four patients in the total parathyroidectomy with autotransplantation group (total PTX+AT) and in three patients in the subtotal parathyroidectomy group (subtotal PTX). Postoperatively, all patients received oral calcium carbonate and calcitriol. The length of average hospital stay was 5 (3-10) days. Including nine patients who underwent successful renal transplantation pre-operative bone symptoms, hypercalcemia, hyperphosphatemia, and an increased alkaline phosphatase levels were improved or resolved in all patients. After a mean follow-up of 65 months, three patients (6%) had persistent and one (2%) had recurrent disease. Conclusion: Total parathroidectomy with auto...

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Section: Discussionsupporting

confidence: 69%

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Sakman¹,

Parsak²,

Balal³

et al. 2014

Balkan Med J

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“…Nonetheless, we constantly mark the autotransplant regions with metallic clips, thereby facilitating a possible reintervention. Cervical thymectomy is favoured by some authors [3,17] but is still far from being considered a standard of care in sHPT. As far as we know there is an ongoing randomised controlled trial (TOPAR PILOT-Trial), started in 2007, which aims to evaluate tPtx with or without thymectomy [9].…”

Section: Discussionmentioning

confidence: 99%

Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

Neagoe

Mureşan

Voidăzan

et al. 2016

Endokrynologia Polska

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Introduction: The need for parathyroidectomy remains high in the group of patients on long-term dialysis with medically refractory secondary hyperparathyroidism (sHPT). We aim to compare the results after subtotal parathyroidectomies (sPtx) and total parathyroidectomies with autotransplant (tPtx + AT) performed for sHPT at a single referral centre. Material and methods:This prospective study comparatively analysed sPtx and tPtx + AT performed in our department between February 2010 and December 2014. We followed-up both surgical techniques, with respect to the main clinical symptoms, laboratory data, mortality, and recurrent disease. Results: Forty-three patients on whom we performed 26 sPtx and 19 tPtx + AT were entered in the study. There were no statistically significant differences between groups as far as demographic and preoperative clinical data are concerned. We did not encounter postoperative mortality in either of the groups. The follow-up period was significantly longer for the sPtx group (p = 0.04). The immediate postoperative serum calcium levels were significantly lower in the tPtx + AT group (p = 0.009). Definitive hypoparathyroidism was encountered in two patients in the sPtx group (8.3%) and in one from the tPtx + AT group (5.26%). Four patients from the sPtx group (16.6%) and three from the tPtx + AT group (15.78%) died during the follow-up due to causes unrelated to parathyroidectomy. Overall we had two recurrences in the sPtx group and none in the tPtx + AT group (p = 0.57).

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“…The frequency of intrathymic parathyroid glands or parathyroid cell rests in patients undergoing PTX for renal HPT varies considerably between 14.8 and 45.3 % [59,60]. However, parathyroid cell nests are not restricted to the thymus and, owing to their embryological origin and subsequent migration, can occur almost anywhere in the neck [61].…”

Section: Surgical Concepts In Renal Hyperparathyroidismmentioning

confidence: 99%

“…Thus, routine bilateral cervical thymectomy (BCT) is a continuous matter of debate in patients undergoing surgery for renal HPT. One large retrospective study on 461 patients [60] (EL 3) undergoing TPTX+AT with routine BCT intrathymic parathyroid glands (IPGs) were identified in 205 (44.5 %) patients, which were supernumerary in 30 patients (6.5 %). The frequency of supernumerary IPGs in patients on permanent hemodialysis was 7.4 % (29/392), 3.9 % (1/26) in predialysis patients, and 0 % (0/43) in patients after successful kidney transplantation.…”

Section: (El 3)mentioning

confidence: 99%

“…Reoperations for persistent or recurrent renal HPT in the neck are challenging due to scar formation aggravating identification of parathyroid glands and meticulous preparation and since they are related to a higher rate of recurrent laryngeal nerve palsy (RLNP, 2 to 10 %) [40,60]. Thus, there are several important aspects to consider.…”

Section: Surgical Approach For Persistent and Recurrent Renal Hyperpamentioning

confidence: 99%

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Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

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105

130

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Background Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. Methods Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.Results Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. Conclusions Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and longterm control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.

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Frequency of Ectopic and Supernumerary Intrathymic Parathyroid Glands in Patients with Renal Hyperparathyroidism: Analysis of 461 Patients Undergoing Initial Parathyroidectomy with Bilateral Cervical Thymectomy

Cited by 72 publications

References 37 publications

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

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