With the advances in techniques of localization, numerous minimally invasive parathyroid surgery were developed including open minimal incision and endoscopic approaches. According to the research results and the experiences from Peking Union Medical College Hospital, the indication and preoperative preparation were discussed in this paper. Some suggestions were given for minimally invasive parathyroid surgery in China.
Beijing ; China ; Humans ; Minimally Invasive Surgical Procedures ; Parathyroidectomy ; methods ; Preoperative Care

Objective:To quantitatively evaluate the risk of recurrence in patients with secondary hyperparathyroidism after parathyroidectomy. Methods:The clinical data of 168 patients who underwent parathyroidectomy（PTX） from June 2017 to May 2019 were collected. The prediction model was constructed by using Akaike information criterion（AIC） to screen factors. A total of 158 patients treated with PTX from June 2019 to September 2021 were included in the validation set to conduct external validation of the model in three aspects of differentiation, consistency and clinical utility. Results:The prediction model we constructed includes different dialysis methods, ectopic parathyroid gland, the iPTH level at one day and one month after surgery, the number of excisional parathyroid and postoperative blood phosphorus. The C index of external validation of this model is 0.992 and the P value of the Calibration curve is 0.886[KG0.5mm]1. The decision curve analysis also shows that the evaluation effect of this model is perfect. Conclusion:The prediction model constructed in this study is useful for individualized prediction of recurrence after PTX in patients with secondary hyperparathyroidism.
Humans ; Parathyroidectomy/methods* ; Parathyroid Hormone ; Retrospective Studies ; Hyperparathyroidism, Secondary/surgery* ; Parathyroid Glands ; Recurrence ; Calcium

BACKGROUNDThe value of gamma probes in the surgical treatment of secondary hyperparathyroidism (sHPT) was determined. The aim of this study was to enhance the rate of successful total parathyroidectomy in patients with sHPT using intraoperative gamma probe investigations.

METHODSWe retrospectively analyzed the clinical data of 48 sHPT patients between May 2007 and September 2011. Preoperative (99)Tc(m)- methoxyisobutyl isonitrile (MIBI) scintigraphy and high-frequency ultrasonography were used for parathyroid localization. Thirty-five patients (group I) underwent conventional neck exploration and open parathyroidectomy. Thirteen patients (group II) underwent gamma probe-guided total parathyroidectomy and parathyroid transplantation. The two groups were compared in terms of the number of parathyroid resections, operative time, and postoperative changes in the blood levels of parathyroid hormone (PTH), calcium, and phosphate.

RESULTSThe clinical manifestations, PTH and calcium levels, age distribution, and clinical characteristics did not differ between the two groups. The accuracy of preoperative (99)Tc(m)-MIBI scintigraphy (89.74%) for the diagnosis of hyperparathyroidism did not differ from that of ultrasonography (81.25%). However, the accuracy of (99)Tc(m)-MIBI scintigraphy (66.67%) for localizing hyperfunctioning parathyroids was significantly lower than that of ultrasonography (76.86%). The operation time was significantly longer in group I ((120 ± 25) minutes) than in group II ((90 ± 30) minutes). The accuracy of parathyroid identification was significantly higher in group II (92.59%) than in group I (80.39%). On average, significantly fewer parathyroid specimens were obtained in group I (2.5 ± 0.5) than in group II (3.5 ± 0.5). Compared with group I, group II showed a significant increase (15.4%) in the number of parathyroid resections. The PTH, calcium, and phosphate levels significantly decreased postoperatively in all patients.

CONCLUSIONSIntraoperative gamma probe examination confirmed that the excised specimen was parathyroid tissue and improved the accuracy of parathyroid resection. The parathyroidectomy rate was increased by 15.4% due to the use of these probes. However, the probes did not detect all ectopic parathyroids, and further research is required to clarify the underlying reasons.

Adult ; Female ; Humans ; Hyperparathyroidism, Secondary ; surgery ; Male ; Middle Aged ; Organotechnetium Compounds ; therapeutic use ; Parathyroidectomy ; methods ; Retrospective Studies ; Ultrasonography ; methods

PURPOSE: Many surgeons intend to preserve all of the parathyroids during a thyroid operation; however, they have had the unpleasant experience of achieving unintentional parathyroidectomy. We studied the risk factors for unin-tentional parathyroidectomy and whether these unintentional parathyroidectomies caused symptomatic hypocalcemia. METHODS: We conducted a retrospective review of the medical records and pathologic reports of 95 papillary carcinoma patients who underwent operations between January 1994 and December 2003. We statistically analyzed the correlation between unintentional parathyroidectomy and the risk factors such as tumor size, capsular invasion, including extra-thyroidal extension, and the operation method. RESULTS: Of the total 95 procedures, 14 (14.7%) produced patho-logy reports stating that incidental parathyroid tissue was identified within the thyroidectomy specimen. The majority of the 14 reported cases contained only a single focus of inci-dental parathyroid tissue; however, one of these thyroidectomy specimens contained two foci of parathyroid tissue. The factors such as tumor size, capsular invasion and extensive surgery were not correlated with the prevalence of unintentional parathyroidectomy. There was no association of unintentional parathyroidectomy with postoperative hypocalcemia (P=.449). CONCLUSION: Unintentional parathyroidectomy is not associated with symptomatic postoperative hypocalcemia. The factors such as tumor size, capsular invasion or extensive surgery are not risk factors for unintentional parathyroidectomy.
Carcinoma, Papillary ; Humans ; Hypocalcemia ; Medical Records ; Methods ; Parathyroidectomy* ; Prevalence ; Retrospective Studies ; Risk Factors ; Surgeons ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Parathyroid adenoma is a major cause of primary hyperparathyroidism. Treatment usually involves the surgical removal of one or more parathyroid glands. However, specific localising techniques have boosted the development of nonsurgical, minimally invasive procedures, such as percutaneous radiofrequency ablation (RFA) under ultrasonographic guidance, which are gaining popularity as a method of treatment. This paper reports two male patients who presented with hypercalcaemia (highest serum calcium level 4.56 mmol/L and 4.57 mmol/L, respectively) and hyperparathyroidism (highest serum parathyroid hormone [PTH] level 772 ng/L and > 1,900 ng/L, respectively) due to solitary parathyroid adenoma. Four days after percutaneous RFA, the serum calcium levels in both patients decreased and PTH levels showed a significant decreasing trend. Both patients recovered well with normal levels of calcium and improvement of symptoms. Thus, we conclude that RFA may be a safe and effective therapeutic option in the treatment of parathyroid adenoma.
Adenoma ; complications ; surgery ; Catheter Ablation ; Humans ; Hyperparathyroidism ; etiology ; surgery ; Male ; Middle Aged ; Parathyroid Neoplasms ; complications ; surgery ; Parathyroidectomy ; methods ; Ultrasonography, Interventional

OBJECTIVETo evaluate the feasibility and efficacy of surgical treatment for patients with primary hyperparathyroidism (pHPT).

METHODSThe studies were analyzed for 55 patients with pHPT who underwent parathyroidectomy in our hospital from 1985 to 2002.

RESULTSEight patients were asymptomatic. The skeletal manifestations were found in 24 cases, urinary stones in 10 cases, and both skeletal manifestations and urinary stones in 13 cases. Pathological bone fractures occurred in 16 cases. Hypercalcemia was discovered in all patients with the average value of (3.1 +/- 0.4) mmol/L, ranging from 2.7 to 3.9 mmol/L and. Fifty patients showed elevated parathyroid hormone (PTH) with the average value of (489.2 +/- 69.2) pg/ml, ranging from 102 to 2,000 pg/ml. Preoperatively all patients underwent sonography, CT and/or scintigraphy. The overall preoperative image-directed localization rate was 90.9%. Follow-up was done from 6 months to 2 years after surgery. The symptoms and signs of all patients relieved postoperatively with the improving of osteoporosis and healing of bone fracture. Of all cases, 39 presented with temporary hypocalcemia, 37 showed circumoral paresthesia in whom 10 showed tetany, 15 showed eucalcemia and one had mild hypercalcemia after operation. The serum calcium was normal in all cases with hypocalcemia by Rocaltrol and calcium supplementation for 1 - 3 weeks. PTH level decreased to normal fro 2 weeks to 2 months in 47 cases and was still mildly higher than normal in 3 cases.

CONCLUSIONSParathyroidectomy is an effective approach to patients with pHPT. With preoperative image-directed localization techniques, minimally invasive parathyroidectomy is a valid surgical strategy.

Adolescent ; Adult ; Aged ; Female ; Humans ; Hyperparathyroidism ; diagnosis ; surgery ; Male ; Middle Aged ; Parathyroidectomy ; methods ; Retrospective Studies ; Treatment Outcome

PURPOSE: The purpose of this study was to investigate the accuracy and reliability of the semi-automated ultrasonographic volume measurement tool, virtual organ computer-aided analysis (VOCAL), for measuring the volume of parathyroid glands. METHODS: Volume measurements for 40 parathyroid glands were performed in patients with secondary hyperparathyroidism caused by chronic renal failure. The volume of the parathyroid glands was measured twice by experienced radiologists by two-dimensional (2D) and three-dimensional (3D) methods using conventional sonograms and the VOCAL with 30°angle increments before parathyroidectomy. The specimen volume was also measured postoperatively. Intraclass correlation coefficients (ICCs) and the absolute percentage error were used for estimating the reproducibility and accuracy of the two different methods. RESULTS: The ICC value between two measurements of the 2D method and the 3D method was 0.956 and 0.999, respectively. The mean absolute percentage error of the 2D method and the 3D VOCAL technique was 29.56% and 5.78%, respectively. For accuracy and reliability, the plots of the 3D method showed a more compact distribution than those of the 2D method on the Bland-Altman graph. CONCLUSION: The rotational VOCAL method for measuring the parathyroid gland is more accurate and reliable than the conventional 2D measurement. This VOCAL method could be used as a more reliable follow-up imaging modality in a patient with hyperparathyroidism.
Follow-Up Studies ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary* ; Imaging, Three-Dimensional ; Kidney Failure, Chronic ; Methods* ; Organ Size ; Parathyroid Glands ; Parathyroidectomy ; Ultrasonography

The causes of osteolytic lesions found in radiological examinations are not quite certain. Therefore, to determine the appropriate treatment method, various approaches and analyzes are required to find the real cause. Hyperparathyroidism is one of the diseases which forms osteolytic bone lesions so-called brown tumor. A 55-year-old woman who had painful osteolytic bone lesions in both hip joint areas was diagnosed as parathyroid carcinoma after serial work-up. She underwent parathyroidectomy and follow-up imaging showed a decrease in brown tumor size and bone consolidation in the subchondral bone destruction area. Proper evaluation of osteolytic bone lesions helps to avoid unnecessary operative treatments and the first choice for the treatment of osteolytic bone lesions caused by parathyroid carcinoma is parathyroidectomy.
Female ; Follow-Up Studies ; Hip Joint ; Humans ; Hyperparathyroidism ; Methods ; Middle Aged ; Osteitis Fibrosa Cystica ; Parathyroid Neoplasms ; Parathyroidectomy

PURPOSE: Incidental resection of parathyroid gland is not uncommon during thyroid surgery and may occur even in experienced thyroid surgeons. The aim of this study was to investigate the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. METHODS: A retrospective review of patients who underwent thyroid surgery between January and December 2008 was carried out. Pathologic reports were reviewed for the presence of parathyroid tissue in resected thyroid specimen. Two groups of patients were studied: a group with incidental parathyroidectomy (Group A) and without incidental parathyroidectomy (Group B). RESULTS: Three hundred and thirty-four thyroid surgery were performed: 194 total thyroidectomies, 18 near- or subtotal thyroidectomies, 44 lobectomies, 23 endoscopic total thyroidectomies, 55 endoscopic lobectomies. Of these, 265 patients (79.3%) were preformed for malignant disease. Incidental parathyroidectomy occurred in 30.5% (102/334) of thyroid surgery. Risk factors for incidental parathyroidectomy included malignant pathology (P<0.001), operation method (P<0.001), lymph node dissection (P<0.001), and extrathyroidal invasion (P=0.001). Biochemical hypocalcemia was defined as a serum calcium levels less than 8.4 mg/dL. Symptomatic hypocalcemia was defined as patient had tingled sense or spasm of muscle and need to add more calcium replacement. In group A, 86 patients (93.5%) had a biochemical hypocalcemia (P=0.001). Symptomatic hypocalcemia developed in 35.3% (36/102) of group A, compared to 20.7% (48/232) in group B (P=0.005). CONCLUSION: Malignant pathology, total thyroidectomy, lymph node dissection, and extrathyroidal invasion were associated with a significantly higher risk of incidental parathyroidectomy during thyroid surgery. Incidental parathyroidectomy resulted in biochemical and symptomatic postoperative hypocalcemia. This study suggests that incidental parathyroidectomy may be a potential complication; therefore, parathyroid glands should be identified and preserved with more meticulous inspection during thyroid surgery.
Calcium ; Humans ; Hypocalcemia ; Incidence ; Lymph Node Excision ; Methods ; Parathyroid Glands ; Parathyroidectomy* ; Pathology ; Retrospective Studies ; Risk Factors* ; Spasm ; Surgeons ; Thyroid Gland* ; Thyroidectomy

Metastatic pulmonary calcification refers to calcium deposition in the normal pulmonary parenchyma and this deposition is secondary to abnormal calcium metabolism. The most common radiologic manifestation consists of poorly-defined nodular opacities that are mainly seen in the upper lung zone. We present here a case of metastatic pulmonary calcification that manifested as atypical, dense, calcium deposition in airspaces within the previously existing consolidation in the bilateral lower lobes, and this process was accelerated by pneumonia-complicated sepsis in a patient with hypercalcemia that was due to hyperparathyroidism.
Calcinosis/*radiography ; Female ; Humans ; Hypercalcemia/etiology ; Hyperparathyroidism/complications/surgery ; Lung Diseases/*radiography ; Middle Aged ; Parathyroidectomy ; Pneumonia/complications ; Shock, Septic/microbiology ; Tomography, X-Ray Computed/methods