Supernumerary parathyroid glands: implications for the surgical treatment of secondary hyperparathyroidism.

Abstract

AbstractOf 20 patients who underwent parathyroidectomy for secondary hyperparathyroidism between 1978 and 1985, recurrent hypercalcemia occurred in 4. Three of the 4 patients had initially undergone total parathyroidectomy with autotransplantation (TP‐A) and the fourth had been subjected to removal of 3 parathyroids with autotransplantation of a portion of 1 of these glands. None of the 5 patients treated by subtotal parathyroidectomy (STP) developed recurrence. One of the 3 cases of recurrent hyperparathyroidism after TP‐A was due to graft overgrowth. Another was caused by supernumerary parathyroids subsequently removed at the time of reexploration of the neck. The third remains hypercalcemic after autograft excision and presumably still has a supernumerary gland in situ. The patient who developed recurrent hypercalcemia after removal of only 3 glands and autotransplantation remains hypercalcemic even after radical graft excision and reexploration of the neck and mediastinum.One patient treated early in the series by total parathyroidectomy without autotransplantation now has measurable levels of serum immunoreactive parathyroid hormone, presumably due to a small residual supernumerary gland. There is, thus, at least presumptive evidence of supernumerary parathyroid glands in 3 (15%) of the 20 patients in this series. The implications of this finding are discussed.