Abstract | HYPOTHESIS: DESIGN: A retrospective cohort study. SETTING: Tertiary referral medical center. PATIENTS: Thirty-four consecutive patients (21 women and 13 men; mean age, 48 years) who underwent neck exploration for THPT. MAIN OUTCOME MEASURES: RESULTS: Twenty-seven patients underwent initial bilateral neck exploration and 7 patients underwent repeat neck exploration for persistent or recurrent THPT. The mean serum total calcium level was 11.2 mg/dL (2.8 mmol/L) (range, 10.3-13.5 mg/dL [2.6-3.4 mmol/L]) and the mean intact parathyroid hormone level was 355 ng/L (range, 95-1236 ng/L). The THPT was due to 4-gland hyperplasia in 33 patients and a single adenoma in only 1 patient. The parathyroid glands were in the normal position in 23 patients and in ectopic locations in 11 patients (8 intrathymic, 1 carotid sheath, 1 tracheoesophageal groove, and 1 intramuscular). Preoperative localizing studies did not identify ectopic or supernumerary glands in any of the patients (ultrasonography, 14 patients; technetium Tc 99m sestamibi, 15; and magnetic resonance imaging, 7). Persistent (n = 5) and recurrent (n = 2) THPT was more common in patients who had an initial 1- or 2-gland excision instead of subtotal or total parathyroidectomy with autotransplantation (P<.001). Four patients had transient hypocalcemia (<8.0 mg/dL [<2.0 mmol/L]), and no other permanent complications or deaths occurred. Biochemical cure was achieved in 94% of patients with a mean follow-up of 4.8 years. CONCLUSIONS: Tertiary hyperparathyroidism is usually due to multiple hyperplastic parathyroid glands, and patients who have initial limited parathyroidectomy have a higher risk of persistent or recurrent THPT.
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Authors | Electron Kebebew, Quan-Yang Duh, Orlo H Clark |
Journal | Archives of surgery (Chicago, Ill. : 1960)
(Arch Surg)
Vol. 139
Issue 9
Pg. 974-7
(Sep 2004)
ISSN: 0004-0010 [Print] United States |
PMID | 15381615
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Parathyroid Hormone
- Calcium
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Topics |
- Adolescent
- Adult
- Aged
- Calcium
(blood)
- Chi-Square Distribution
- Female
- Humans
- Hyperparathyroidism
(etiology, surgery)
- Male
- Middle Aged
- Parathyroid Hormone
(blood)
- Parathyroidectomy
- Postoperative Complications
- Retrospective Studies
- Treatment Outcome
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