Human parathyroid blood supply determined by laser‐Doppler flowmetry

Johansson, K.-A.; Ander, Stefan; Lennquist, Sten; Smeds, Staffan

doi:10.1007/bf00316825

Cited by 34 publications

(24 citation statements)

References 12 publications

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“…They also demonstrated the occurrence of two or more feeding arteries in one-third of the parathyroid glands. These findings are not concordant with earlier anatomic studies, which demonstrated that the glands were supplied by a single artery mostly arising from the inferior thyroid artery [5,6], but they are in accordance with our functional studies of the vascular supply in normal parathyroid glands [13].…”

Section: Discussionsupporting

confidence: 73%

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Blood Supply and Parathyroid Hormone Secretion in Pathological Parathyroid Glands

Ander

Johansson²,

Smeds³

1996

World j. surg.

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The blood supply of pathologic parathyroid glands and the relation between parathyroid hormone secretion and parathyroid blood perfusion was studied during surgery for hyperparathyroidism. Blood flow in 39 single adenomas and 20 glands classified as primary or secondary hyperplasia were studied intraoperatively with laser Doppler flowmetry. The ipsilateral inferior thyroid artery was occluded during continuous flowmetry recording, which resulted in a 40% reduction of parathyroid blood flow in both groups. In 12 patients with single adenomas, intact parathormone (iPTH) was measured intraoperatively before and during occlusion of the ipsilateral inferior thyroid artery and after extirpation of the adenoma. During occlusion the iPTH levels were mainly unchanged despite blood flow reduction of up to 80%. After removal of the adenoma the iPTH normalized within 15 minutes. In a control group of eight single adenomas, iPTH was measured similarly without vascular occlusion, demonstrating comparable iPTH levels. This study demonstrates similar routes of vascularization for single adenomas and hyperplastic glands, as was earlier seen for normal parathyroid glands. The increased parathyroid hormone secretion from single adenomas appears to remain mainly unchanged during significant blood flow reduction.

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Section: Discussionsupporting

confidence: 73%

“…Functional studies of parathyroid blood supply have been possible, and an earlier study demonstrated a variable arterial blood supply to normal parathyroid glands [13]. The variability of LDF in repetitive recordings in normal and pathologic glands is not known.…”

mentioning

confidence: 99%

Blood Supply and Parathyroid Hormone Secretion in Pathological Parathyroid Glands

Ander

Johansson²,

Smeds³

1996

World j. surg.

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“…Curtis reported the presence of anastomoses between parathyroid arteries and thyroid glandular tissue, which were spared after subtotal thyroidectomy [26]. Furthermore, several other studies reported that parathyroid vascularization may also be compensated through anastomotic circuits via peritracheal and/or periesophageal arteries [27][28][29]. Hence, no significant difference in term of postoperative hypocalcemia have been observed after subtotal thyroidectomy between patients undergoing ITA truncal ligature and those undergoing terminal branch ITA ligature [9,12].…”

Section: Discussionmentioning

confidence: 97%

Terminal ligature of inferior thyroid artery branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels

Cocchiara

Cajozzo

Amato

et al. 2010

Journal of Visceral Surgery

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“…As a prerequisite to improve the standard of care, various unresolved questions have to be answered concerning the number [6,18,19], blood supply [20,21] and discolouration of parathyroid glands [22,23]. Furthermore the effectiveness of autotransplantation is discussed controversially in literature [9,[24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Protocol of a prospective study for parathyroid function monitoring during and after thyroidectomy

Ott¹,

Promberger²,

Karik³

et al. 2006

Eur Surg

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Zusammenfassung. Grundlagen: Der Hypoparathyreoidismus ist eine unterschätzte Komplikation nach Schilddrüsenoperation. Die Erkennung der zugrundeliegenden Störung des Parathormon (PTH)-und Kalziummetabolismus erfordert prospektive Langzeitstudien. Es besteht die Annahme, dass die sorgfältige Präparation der Nebenschilddrüsen das Risiko der permanenten Hypokalzämie reduziert. Prospektive evidenzbasierte Daten zur Erstellung von Leitlinien fehlen.Methodik: Wir stellen drei Studienprotokolle vor und erläutern sie anhand eines Fallbeispiels: (i) das Monitoring der perioperativen Parathormon-und Kalziumkinetik, (ii) die genaue Beschreibung des intraoperativ-topographischen Nebenschilddrüsensitus und (III) die Erfassung der Hypokalzämie-typischen Symptome.Ergebnisse: Studienziel ist die Definition von prognostischen Parametern (PTH cut-off Wert) für die Vorhersage des permanenten Hypoparathyreoidismus anhand der intra-und postoperativen PTH-Kinetik. Bei unserem Indexpatienten fielen die intraoperativen Parathormonwerte von 36,1 pg/ml auf 8,3 pg/ml (23 %). Zwei Nebenschilddrüsen wurden vom Operateur gesehen und sorgfältig erhalten, zwei blieben unerkannt. Die Funktion der Nebenschilddrüsen erholte sich innerhalb von vierzehn Tagen. Am ersten postoperativen Tag fielen die Kalziumwerte im Serum von 2,21 mmol/l auf einen Tiefstwert von 1,98 mmol/l, ohne dass die Patientin Hypokalzämie-typische Symptome entwickelte.Schlussfolgerungen: Trotz eines klinisch unauffälligen postoperativen Verlaufes kann eine beträchtliche Störung der Parathormonsekretion -bedingt durch die Schilddrü-senoperation -vorliegen. Unsere Protokolle stellen die Basis zur prospektiven Analyse des Mechanismus der postoperativen Nebenschilddrüseninsuffizienz dar.Schlüsselwörter: Hypoparathyreoidismus, Hypokalzämie, Thyreoidektomie, Parathormon, Komplikation.Summary. Background: Hypoparathyroidism still remains an underestimated complication after thyroidectomy; the kinetics of parathyroid hormone (PTH) are poorly understood. It is generally assumed that careful surgical preparation reduces the risk for postoperative persistent hypocalcaemia, but the standard of surgical care is illdefined.Methods: We designed three protocols in order to (i) define the perioperative PTH-and Ca 2+ -kinetics, (ii) delineate intraoperatively the anatomic location of the parathyroid glands, (iii) correlate the temporal evolution of clinical symptoms of hypocalcaemia with the plasma levels of Ca 2+ and PTH.Results: The objective is to define perioperative parameters that may be predictive of persistent hypocalcemia. We tested the feasibility of our approach in a patient undergoing thyroidectomy for multinodular goitre: during surgery, PTH declined from 36.1 pg/ml to only 8.3 pg/ml (i.e. 23%). Two parathyroid glands were detected by the surgeon and carefully preserved, 2 glands remained invisible. However, parathyroid function recovered within 14 days. Calcium-levels fell from 2.21 mmol/l to a minimum of 1.98 mmol/l on the first postoperative day, but hypocalcaemia-related sympto...

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Human parathyroid blood supply determined by laser‐Doppler flowmetry

Cited by 34 publications

References 12 publications

Blood Supply and Parathyroid Hormone Secretion in Pathological Parathyroid Glands

Blood Supply and Parathyroid Hormone Secretion in Pathological Parathyroid Glands

Terminal ligature of inferior thyroid artery branches during total thyroidectomy for multinodular goiter is associated with higher postoperative calcium and PTH levels

Protocol of a prospective study for parathyroid function monitoring during and after thyroidectomy

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