Background Parathyroid cryopreservation is often utilized for patients having parathyroidectomy. This allows for future autotransplantation if a patient becomes permanently hypocalcemic after surgery. However, the practice of cryopreservation is costly and time consuming, while the success rate of delayed autotransplantation is highly variable. We sought to determine the rate and outcomes of parathyroid cryopreservation and delayed autotransplantation at our institution to further evaluate its utility. Methods At our institution, 2,083 parathyroidectomies for hyperparathyroidism (HPT) were performed from 2001–2010. Of these, parathyroid cryopreservation was utilized in 442 patients (21%). Patient demographics, preoperative diagnoses, and other characteristics were analyzed, as well as the rate and success of delayed autotransplantation. Results Of the 442 patients with cryopreservation, the mean age was 55 ± 1 years and 313 (70.8%) were female. 308 (70%) had primary HPT, 46 (10%) had secondary HPT, and 88 (20%) had tertiary HPT. Delayed autotransplantation of cryopreserved parathyroid tissue was used in 4 (1%) patients at an average time of 9 ± 4 months after initial surgery. 3 out of the 4 patients remained hypoparathyroid following this procedure. The one cured patient underwent the procedure only 4 days following the initial parathyroidectomy. Conclusion While cryopreservation was used in over 1/5 of patients undergoing parathyroidectomy, the need for parathyroid reimplantation was very low (1%). Furthermore, the success rate of parathyroid autotransplantation was poor in these patients. Therefore, the continued practice of parathyroid cryopreservation is questionable.

Background Twenty-five percent of Medullary Thyroid Cancer (MTC) cases are hereditary. The ideal age for prophylactic thyroidectomy is based upon the specific RET mutation involved. The aim of this study is to determine if such age-appropriate prophylactic thyroidectomy results in improved disease-free survival. Methods Twenty-eight patients underwent thyroidectomy for hereditary MTC at our institution. Age-appropriate thyroidectomy was defined according to the North American Neuroendocrine Tumor Society (NANETS) guidelines. Patients having age-appropriate surgery (Group 1, n=9) were compared to those having thyroidectomy past the recommended age (Group 2, n=19). Results The mean age was 13 ± 2 years and 61% were female. Patients in Group 1 were younger than Group 2 (4 ± 1 vs. 17 ± 2 years, p<0.01). There were no significant differences in gender or RET mutation types between these two groups. Group 1 patients were cured with no disease recurrence as compared to Group 2 patients who had a 42% recurrence rate (p=0.05). Sub-analysis of Group 2 identified that patients who underwent surgery without evidence of disease did so at a shorter period following the guidelines as compared to those who underwent therapeutic surgery (2 ± 2 vs. 16 ± 2 years, p=0.01) and had longer disease-free survival (100% vs. 27%, p=0.005). Conclusion Patients with hereditary MTC should undergo age-appropriate thyroidectomy based on RET mutational status to avoid recurrence. Patients who are past the recommended age should have surgery as early as possible in order to improve disease-free survival.

Background-Twenty-five percent of Medullary Thyroid Cancer (MTC) cases are hereditary. The ideal age for prophylactic thyroidectomy is based upon the specific RET mutation involved. The aim of this study is to determine if such age-appropriate prophylactic thyroidectomy results in improved disease-free survival. Methods-Twenty-eight patients underwent thyroidectomy for hereditary MTC at our institution. Age-appropriate thyroidectomy was defined according to the North American Neuroendocrine Tumor Society (NANETS) guidelines. Patients having age-appropriate surgery (Group 1, n=9) were compared to those having thyroidectomy past the recommended age (Group 2, n=19). Results-The mean age was 13 ± 2 years and 61% were female. Patients in Group 1 were younger than Group 2 (4 ± 1 vs. 17 ± 2 years, p<0.01). There were no significant differences in gender or RET mutation types between these two groups. Group 1 patients were cured with no disease recurrence as compared to Group 2 patients who had a 42% recurrence rate (p=0.05). Subanalysis of Group 2 identified that patients who underwent surgery without evidence of disease did so at a shorter period following the guidelines as compared to those who underwent therapeutic surgery (2 ± 2 vs. 16 ± 2 years, p=0.01) and had longer disease-free survival (100% vs. 27%, p=0.005). Conclusion-Patients with hereditary MTC should undergo age-appropriate thyroidectomy based on RET mutational status to avoid recurrence. Patients who are past the recommended age should have surgery as early as possible in order to improve disease-free survival.