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

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: 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

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

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

A young woman with severe vitamin D deficiency presented with proximal muscle weakness, fragility fracture and pseudoarthrosis. On evaluation, she was found to have hypercalcaemia, a single parathyroid adenoma and an undetectable 25-hydroxyvitamin D level. She received parenteral cholecalciferol and subsequently underwent curative parathyroidectomy. Postoperatively, she had hungry bone syndrome, which she gradually recovered from with calcium and calcitriol replacement. Notably, her calcium levels were in the lower limit of normal range and associated with elevated alkaline phosphatase levels at postoperative Day 14. Follow-up for the next four years showed that the patient had remarkable symptomatic and radiological improvements. In this report, we discuss the pathophysiological interactions between vitamin D deficiency and associated primary hyperparathyroidism.
Adenoma ; diagnosis ; diagnostic imaging ; surgery ; Adult ; Female ; Follow-Up Studies ; Fractures, Spontaneous ; diagnostic imaging ; etiology ; surgery ; Humans ; Hyperparathyroidism, Primary ; complications ; diagnosis ; surgery ; Low Back Pain ; diagnosis ; etiology ; Muscle Weakness ; diagnosis ; etiology ; Parathyroid Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Parathyroidectomy ; methods ; Pseudarthrosis ; diagnostic imaging ; etiology ; physiopathology ; Radiography ; Severity of Illness Index ; Singapore ; Treatment Outcome ; Vitamin D Deficiency ; complications ; diagnosis

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

PURPOSE: Incidental parathyroidectomy is the most common and unexpected consequence of a total thyroidectomy. It can cause hypocalcemia symptoms such as muscle cramping and even seizures. We conducted this study to compare several factors including the preservation rate of parathyroid glands during both a bilateral axillo-breast approach endoscopic thyroidectomy (BABA) and a conventional open thyroidectomy (CT) for papillary thyroid carcinomas. METHODS: We retrospectively reviewed the medical records of 299 papillary thyroid cancer patients who had a total thyroidectomy between January 2008 and December 2011. We grouped the patients into two groups: BABA (n=70) and CT (n=229). We analyzed age, tumor size, operation time, the number of preserved and removed parathyroid glands, amount and duration of seroma drainage, pain score, hypocalcemia symptoms, and serum total calcium level in both the BABA and CT groups. RESULTS: We observed a younger age (under 45 years old) (P=0.000), smaller tumor size (P=0.000), longer operation time (P=0.000), larger amount of drainage (P=0.000), longer duration of drainage (P=0.007), and larger pain score (P=0.000) in the BABA group. Of the 70 patients that received an endoscopic thyroidectomy, we preserved all four parathyroid glands in 56 patients (78.6%). Of the 229 patients that received an open thyroidectomy, we preserved all four parathyroid glands in 141 patients (61.6%, P=0.004). CONCLUSION: BABA results in more extensive tissue damage over a longer period of time than CT. However, BABA was an excellent method for preserving parathyroid glands when compared with CT for thyroid carcinoma. Thus, it seems to be feasible performing BABA when it matches the indications.
Calcium ; Drainage ; Humans ; Hypocalcemia ; Hypoparathyroidism ; Medical Records ; Methods ; Muscle Cramp ; Parathyroid Glands* ; Parathyroidectomy ; Retrospective Studies ; Seizures ; Seroma ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy*

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

OBJECTIVETo investigate the diagnosis and surgical treatment of parathyroid carcinoma.

METHODSThe clinical data of 9 cases of parathyroid carcinoma treated from January 1967 to December 2009 was analyzed retrospectively with the review of related Chinese literatures.

RESULTSParathyroid carcinoma accounted for 8.9% (8/90) of all patients with primary hyperparathyroidism in our hospital, and the other one case was transferred from another hospital. Of the patients, 8 cases were found with primary hyperparathyroidism. Primary surgery was carried out with small incision: 5 patients underwent en bloc resection, among which, 3 cases received central lymph node dissection; 2 patients received simple parathyroidectomy; one case underwent palliative tumor resection. The case from another hospital received subtotal thyroidectomy. Considering preoperative, intraoperative data and frozen sections pathology, all patients were diagnosed as parathyroid carcinoma. Nine patients were followed-up for 1 - 14 years, no recurrence occurred, and the patient received palliative resection died from carcinoma two years after the operation. In previous Chinese literatures and this group, there were total 146 patients reported as parathyroid carcinoma. Those patients were diagnosed through routine histopathology, accounted for 1.8% - 11.5% of patients with primary hyperparathyroidism.

CONCLUSIONSThe diagnosis of parathyroid carcinoma is established according to severe hypercalcemia, clinical features, subset B-ultrasound and Tc(99m)-sestamibi scanning, intraoperative finding of adherence to close structures and histopathology. The initial surgical procedure of choice is en bloc resection of the tumor by minimally invasive small incision, including adjacent structures and ipsilateral thyroidectomy. The prognosis is favorable after the operation.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Hypercalcemia ; diagnosis ; etiology ; Hyperparathyroidism, Primary ; diagnosis ; etiology ; Lymph Node Excision ; Male ; Middle Aged ; Parathyroid Neoplasms ; complications ; diagnosis ; pathology ; therapy ; Parathyroidectomy ; methods ; Retrospective Studies ; Technetium Tc 99m Sestamibi