Faculty Collaboration Database

Subtotal parathyroidectomy for primary hyperparathyroidism. Endocr Pract 2011;17 Suppl 1:7-12

Date

12/08/2010

Pubmed ID

21134873

DOI

10.4158/EP10290.RA

Scopus ID

2-s2.0-79959512999 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

OBJECTIVE: To discuss the etiology of multiple gland disease in the context of primary hyperparathyroidism, as well as indications for surgery, operative management and technical considerations of subtotal parathyroidectomy, and postoperative/long-term management.

METHODS: We conducted a systematic review of the literature using evidence-based criteria.

RESULTS: Approximately 15% of patients with primary hyperparathyroidism have multiple gland disease, and a small subset of these cases is due to a familial syndrome. Subtotal parathyroidectomy is one operative approach to the management of multiple gland disease. Subtotal parathyroidectomy for multiple gland disease results in normocalcemia in at least 95% of cases. Intraoperative parathyroid hormone monitoring can help guide the extent of the operation and determine the need to perform a concurrent autograft. After subtotal parathyroidectomy, most patients develop postoperative hypocalcemia and require calcium and possibly calcitriol supplementation; approximately 10% to 15% develop permanent hypoparathyroidism. All patients after parathyroidectomy, especially those with familial primary hyperparathyroidism, should undergo long-term follow-up for surveillance of recurrent primary hyperparathyroidism. If persistent or recurrent primary hyperparathyroidism occurs after subtotal parathyroidectomy, completion total parathyroidectomy and parathyroid autotransplant should be performed.

CONCLUSIONS: Subtotal parathyroidectomy is an excellent surgical approach for patients with primary hyperparathyroidism due to multiple gland disease from either sporadic or familial causes.

Author List

Yen TW, Wang TS

Authors

Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Humans
Hyperparathyroidism, Primary
Parathyroidectomy