PMID- 18043113
OWN - NLM
STAT- MEDLINE
DCOM- 20080124
LR  - 20071128
IS  - 0003-4932 (Print)
IS  - 0003-4932 (Linking)
VI  - 246
IP  - 6
DP  - 2007 Dec
TI  - Is total parathyroidectomy the treatment of choice for hyperparathyroidism in 
      multiple endocrine neoplasia type 1?
PG  - 1075-82
AB  - OBJECTIVE: The aim of the present report is to describe the results obtained with 
      total parathyroidectomy (TPTX) guided by rapid intraoperative parathyroid hormone 
      (PTH) evaluation, followed by immediate parathyroid autograft with fresh tissue. 
      SUMMARY BACKGROUND DATA: Surgery for hyperparathyroidism (HPT) in multiple 
      endocrine neoplasia type 1 (MEN1) is performed with various surgical approaches. 
      METHODS: We report our 16-year experience of surgical treatment of 51 MEN1-HPT 
      patients using TPTX and thymectomy. Forty-five patients underwent TPTX as the 
      first surgical procedure, whereas for 6 patients, a parathyroid operation was the 
      second surgical procedure. PTH intraoperative values less than 10 pg/mL, at the 
      end of the surgery, were indicative for reimplantation of a few fragments ( 
      approximately 7) of fresh parathyroid tissue in the brachioradial muscle of the 
      forearm. Parathyroid autograft was performed in all patients, except 3 in whom 
      the fourth parathyroid gland was not found. RESULTS: Persistent 
      hypoparathyroidism occurred in 13 patients (25%), with higher incidence in 
      patients undergoing a second surgical revision for cervical recurrence than in 
      patients submitted to the first surgery. At follow-up, 5 recurrences ( 
      approximately 10%) in the forearm were observed after a mean time of 7 +/- 5 (M 
      +/- SD) years. No cervical recurrence was documented. The forearm recurrence was 
      treated with removal of 1 or 2 enlarged fragments obtaining the resolution of HPT 
      in all but 1 case. CONCLUSIONS: Based on the occurrence of complications in our 
      experience, TPTX followed by autograft and guided by intraoperative PTH 
      monitoring represents a better surgical option in MEN1-HPT compared with other 
      surgical approaches.
FAU - Tonelli, Francesco
AU  - Tonelli F
AD  - Department of Clinical Physiopathology, University of Florence, Medical 
      SchoolFlorence, Italy. f.tonelli@dfc.unifi.it
FAU - Marcucci, Tommaso
AU  - Marcucci T
FAU - Fratini, Geri
AU  - Fratini G
FAU - Tommasi, Maria Silvia
AU  - Tommasi MS
FAU - Falchetti, Alberto
AU  - Falchetti A
FAU - Brandi, Maria Luisa
AU  - Brandi ML
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Hyperparathyroidism/etiology/*surgery
MH  - Male
MH  - Middle Aged
MH  - Multiple Endocrine Neoplasia Type 1/*complications/surgery
MH  - Parathyroid Neoplasms/*complications/surgery
MH  - Parathyroidectomy/*methods
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2007/11/29 09:00
MHDA- 2008/01/25 09:00
CRDT- 2007/11/29 09:00
PHST- 2007/11/29 09:00 [pubmed]
PHST- 2008/01/25 09:00 [medline]
PHST- 2007/11/29 09:00 [entrez]
AID - 00000658-200712000-00023 [pii]
AID - 10.1097/SLA.0b013e31811f4467 [doi]
PST - ppublish
SO  - Ann Surg. 2007 Dec;246(6):1075-82. doi: 10.1097/SLA.0b013e31811f4467.