What to do when the parathyroid gland is not found during a transcervical exploration?

Abstract

The most frequent cause of suboptimal results in a parathyroid adenoma resection is an ectopic location, mainly in the anterior mediastinum. These cases may not always be resected through a traditional cervical access. We present 2 cases of primary hyperparathyroidism who underwent an unsuccessful bilateral cervical exploration due to parathyroid tissue located inside the thymic gland. A video-assisted thoracoscopic surgery thymectomy with intraoperative determination of blood parathormone levels was performed. A 50% reduction of intraoperatory parathyroid hormone blood from the highest basal level at 5 and 10 min after resection was obtained. Final pathological results showed an intra-thymic parathyroid adenoma in the first patient and an intra-thymic focus of parathyroid hyperplasia in the second patient. In conclusion, video-assisted thoracoscopic surgery thymectomy could be the optimal approach to resect ectopic parathyroid adenomas located in the anterior mediastinum.

Limits to in vivo fate changes of epithelia in thymus and parathyroid by ectopic expression of transcription factors Gcm2 and Foxn1

“…Ectopic parathyroid tissue is also often found in scattered locations in the neck, and indeed in the mediastinum adjacent to or inside thymic lobes (Fig. 1 b) 20 ; in humans, this presents a significant challenge when extirpation of parathyroid adenomas is required 21 . Ectopic parathyroid tissue may not always result from aberrant migration to the final anatomical location next to the thyroid, but could, in analogy to the situation of the parathyroid-fated cervical thymi, originate from trans-fated thymic epithelium (Fig.…”