Enlarged parathyroid glands discovered in normocalcemic patients during thyroid surgery

Abboud, Bassam; Sleilaty, Ghassan; Braidy, C.; Ghorra, Claude; Abadjian, Gerard; Tohme, Cyril; Noun, Roger; Sarkis, Riad

doi:10.1016/j.amjsurg.2007.01.033

Cited by 14 publications

(16 citation statements)

References 9 publications

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“…However, autopsy studies have found that 1.9–7.6% of people have enlarged parathyroid glands without biochemical or clinical abnormalities and a similar range has been reported by endocrine surgeons [1–12]. …”

Section: Discussionsupporting

confidence: 57%

Incidental Parathyroid Disease during Thyroid Surgery: Should We Remove Them?

2011

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Aim. Despite an incidence of parathyroid “incidentalomas” of 0.2%–4.5%, only approximately 135 cases have been reported in the literature. We present eight patients in whom an incidental abnormal parathyroid gland was found during routine thyroid surgery. We have reviewed the literature and postulate whether these glands could represent further evidence of a preclinical stage of primary hyperparathyroidism. Methods. A retrospective analysis of all 236 thyroid operations performed by a single surgeon was performed to identify patients in whom abnormal parathyroid tissue was removed at surgery. Results. 8/236 patients (3.39%) had a single macroscopically abnormal parathyroid gland removed and sent for analysis. Seven patients were found to have histological evidence of a parathyroid adenoma or hyperplasia. None of the patients had abnormal serum calcium detected preoperatively. Postoperatively, four patients had normal calcium, three had temporary hypocalcaemia and one refused followup. No patients had recurrent laryngeal nerve impairment. Conclusions. Despite the risk of removing a histologically normal gland, we believe that when parathyroid “incidentalomas” are found during surgery they should be excised and sent for histological analysis. We have found this to be a safe procedure with minimal morbidity to the patient. As the natural history of primary hyperparathyroidism is better understood, these glands found in normocalcaemic patients may in fact represent the early or preclinical phase of the disease. By removing them at the original operation, the patient is saved redo neck surgery with its high complication rate as or when clinically apparent primary hyperparthryoidism develops in the future.

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Section: Discussionsupporting

confidence: 57%

Incidental Parathyroid Disease during Thyroid Surgery: Should We Remove Them?

2011

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“…There were significantly more parathyroid hyperplasia than in patients undergoing parathyroidectomy for PHPT and 72.7% of patients had a well-differentiated thyroid carcinoma on final pathology [12]. We suggested that enlarged parathyroid glands in normocalcemic patients could be the first step toward an overt biochemical PHPT with a mutation of the calcium sensor and that mild hyperfunctioning was already present.…”

Section: Discussionmentioning

confidence: 84%

“…In a previous study conducted by our institution [12], we found 1.9% of incidental parathyroid pathology during thyroid surgery in normocalcemic patients. There were significantly more parathyroid hyperplasia than in patients undergoing parathyroidectomy for PHPT and 72.7% of patients had a well-differentiated thyroid carcinoma on final pathology [12].…”

Section: Discussionmentioning

confidence: 92%

“…Papillary thyroid carcinoma which is the most frequently cited in our series and in the literature has been linked to a somatic RET proto-oncogene mutation in 11% to 40% of cases [6][7][8][9][10][11]. Furthermore, parathyroid pathology without overt parathyroid hyperfunction is linked to the well-differentiated carcinoma [12]. In our series, 64% of patients were normocalcemic with a median calcium level of 2.43 mmoL/L (range 2.03-3.81mmoL/L).…”

Section: Discussionmentioning

confidence: 93%

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Association of parathyroid pathology with well-differentiated thyroid carcinoma

Ghorra¹,

Rizk²,

Hachem³

et al. 2012

La Presse Médicale

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“…Early diagnosed asymptomatic or clinically minimal apparent PHPT showed to be caused more often by MGD than symptomatic and clinically evident PHPT [13,14]. Whereas up to five times more adult women are affected compared to adult men, the rate of male patients in the younger group is slightly higher.…”

Section: Discussionmentioning

confidence: 94%