Surgical Treatment Of Primary Hyperparathyroidism: Which Therapy To Whom?

Abstract

Primary hyperparathyroidism (pHPT) is characterized by an increase in the levels of PTH and Ca, or one of these (Ca, PTH) as a result of a dysregulation of calcium (Ca) metabolism due to inappropriate excess parathyroid hormone (PTH) autonomously produced from one or more than one parathyroid glands. Ninety to 95% of pHPT is a sporadic type, which is not associated with the familial history and other endocrine organ tumors, and 5-10% of it is hereditary. While 80-85% of pHPT arises from a single parathyroid adenoma, 4-5% is caused by a double adenoma, 10-15% by multigland hyperplasia and less than 1% by parathyroid cancer. The diagnosis of pHPT is reached biochemically. The only curative treatment of pHPT is surgery. The choice of surgery in pHPT may vary depending on whether the patient has hereditary HPT or thyroid disease requiring surgical treatment, preoperative localization studies and the findings in these studies, the possibilities of using intraoperative PTH and the preference of the surgeon. The preoperatively determined surgical strategy can be revised according to intraoperative findings in case of need to achieve excellent results. The two main approaches in the surgical treatment of pHPT are BNE (bilateral neck exploration) and MIP (minimal invasive parathyroidectomy). Although BNE is a consistently valid option that has excellent results in the surgical treatment of pHPT and is considered the gold standard, MIP is the ideal approach in selected patients with clinically and radiologically considered a single-gland disease. Negative imaging is not a contraindication for parathyroid surgery and is not a criterion for the presence or absence of surgical indication. Although both methods are safe and effective in the surgical treatment of sporadic pHPT, there is still controversy regarding the effectiveness of both methods. Surgical intervention should establish the risk-benefit balance well, minimize the risk of persistent and recurrent disease and provide the highest cure rate without increasing the risk of complications. Complication rates are higher in the secondary surgery, thus in secondary procedures, selective surgery should be performed under guidance of an imaging modality. The surgical strategy should be determined to achieve maximum cure with minimum dissection and minimal morbidity. In this study, we aimed to determine the type of surgical treatment and pHPT patients suitable for the surgical treatment.

Ectopic Parathyroid Adenoma in an 11-Year-Old Girl: Case Report and Literature Review

“…Notably, 4D CT has been increasingly used and is even used as a first-line imaging choice in some centers. 43 Its use in pediatric cases may be limited to a secondary role due to high radiation exposure. 11 To date, the pediatric literature on 4D CT has been limited to case reports, and future studies should investigate its role in diagnosing parathyroid adenomas in this population.…”

Hiperparatiroidismo primario por adenoma gigante de paratiroides Abordaje quirúrgico selectivo

“…La incisión clásica y patrón oro para el tratamiento del hiperpartiroidismo primario eutópico es la cervicotomía arciforme de Kocher (11) . A través de ella se accede a la logia tiroidea, y luego de la movilización del lóbulo tiroideo correspondiente, se accede a la paratiroides patológica.…”

Clinical adaptation of auxiliary methods and multidisciplinary approach to changing trends in parathyroid surgery

“…Besides, it has many advantages for patients, and also reliable for the surgeon because of reduced complication rates. [ 18 ] In our center, we established a standard treatment algorithm with the multidisciplinary endocrine council for evaluating patients with PHPT. With the application of adjunct techniques such as 4D-CT, IO-PTH, and ASVS within the availability of our hospital, the rate of MIP increased and complication rates decreased.…”