Clinics (Jan 2012)

Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

  • Fabio Luiz de Menezes Montenegro,
  • Delmar Muniz Lourenço Junior,
  • Marcos Roberto Tavares,
  • Sergio Samir Arap,
  • Climerio Pereira Nascimento Junior,
  • Ledo Mazzei Massoni Neto,
  • André D'Alessandro,
  • Rodrigo Almeida Toledo,
  • Flávia Lima Coutinho,
  • Lenine Garcia Brandão,
  • Gilberto de Britto e Silva Filho,
  • Anói Castro Cordeiro,
  • Sergio Pereira Almeida Toledo

DOI
https://doi.org/10.6061/clinics/2012(Sup01)22
Journal volume & issue
Vol. 67
pp. 131 – 139

Abstract

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Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/ multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1.

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