Multiglandular Parathyroid Gland Disease: an Incidental Discovery in Normocalcemic Patients During Thyroid Surgery

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 2+) 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 2+ in normocalcemic patients diagnosed with incidental MGD. Study design. A prospective study of patients with normal preoperative Ca 2+ 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 2+. Further data analyses showed patients with MGD and high normal (≥1.25-1.3 mmol/L) serum Ca 2+ (n = 89) and with moderate-low (1.0-1.24 mmol/L) serum Ca 2+ (n = 130). Results. Primary hyperparathyroidism was diagnosed intra-and post-operatively in 48 (54%) patients with high-normal serum Ca 2+ and in 2 (2%) patients with moderate-low serum Ca 2+ (p<0.0001). Parathyroid hormone, serum Ca 2+ as well as urine calcium excretion were elevated in 2 (2%) patients with moderate-low serum Ca 2+ and in 18 (20%) patients with high-normal Ca 2+ at follow-up (p<0.0001). Conclusion. Serum Ca 2+ 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.

Improved intraoperative verification of parathyroid glands by determining their autofluorescence in the infrared spectrum

“…Доцільно відзначити, що для досвідченого ендокринного хірурга ідентифікація навколощитоподібних залоз є завданням, що можливе для вирішення в більшості випадків за умови первинного хірургічного втручання на шиї [6]. Однак анатомічна локалізація навколощитоподібних залоз складна при оперативному втручанні з приводу рецидиву раку щитоподібної залози, гіперпаратиреозу та при мультигландулярній хворобі навколощитоподібних залоз чи при їх інтратиреоїдному розташуванні, або інших анатомічних варіаціях [7,8]. Передопераційна верифікація аденоми навколощитоподібних залоз здійснюється за допомогою сцинтиграфії з 99mTc-MIBI чи застосуванні комп'ютерної томографії.…”

“…Так само як і інші автори, ми ідентифікували всі навколощитоподібні залози у більшості випадків візуально, користуючись анатомічними орієнтирами [1,4,6,7,16]. Тим не менше ми не були впевнені щодо розташування навколощитоподібних залоз у 12 (19 %)…”

Challenges of Differential Diagnosis Between Primary Hyperparathyroidism and Bone Metastases of Breast Cancer

“…Hypercalcemia and bone lesions are also symptoms of primary hyperparathyroidism (PHPT). 4 , 5 Hypercalcemia in PHPT appears as a response to the overproduction of PTH by parathyroid adenoma (PTA) or carcinoma. 5 , 6 PHPT might be asymptomatic, normocalcemic, or with an unusual presentation, causing no specific symptoms; and therefore, it might escape from the early diagnosis and subsequently cause severe complications.…”

“…4 , 5 Hypercalcemia in PHPT appears as a response to the overproduction of PTH by parathyroid adenoma (PTA) or carcinoma. 5 , 6 PHPT might be asymptomatic, normocalcemic, or with an unusual presentation, causing no specific symptoms; and therefore, it might escape from the early diagnosis and subsequently cause severe complications. 4 , 5 , 7 , 8 Bone loss should always be considered in patients with breast cancer due to hormone-ablative therapy.…”

Intraoperative detection of parathyroid glands by autofluorescence identification using image-based system: report of 15 cases

“…It is worth to mention that visual identification of parathyroid glands is easily performed by experienced endocrine surgeons in patients without prior surgery of the central neck compartment [ 3 , 4 ]. However anatomical location of parathyroid glands is different in the case of surgical interventions for recurrent thyroid cancer or hyperparathyroidism as well as in the case of multiglandular parathyroid gland disease or intrathyroidal localization or other anatomical variations [ 5 – 8 ]. The parathyroid adenoma site is preoperatively identified by 99mTc-sestamibi scintigraphy or computed tomography (CT) scan [ 6 ].…”