Lower Parathyroid Gland Research Articles

Non-functioning parathyroid cysts

To study the features of clinical course, diagnosis and treatment of true non-functioning parathyroid cysts. We retrospectively analyzed 18 patients with non-functioning true parathyroid cysts. Inclusion criteria: US-confirmed anechoic lesion of the neck without tissue component, cytological data on cystic lesion, high cystic parathyroid hormone and no laboratory signs of hyperparathyroidism. Non-functioning parathyroid cysts were asymptomatic and diagnosed accidentally after ultrasound of the neck. All patients were women aged 35-77 years. Four patients had cysts near the upper parathyroid glands, 14 patients - near the lower parathyroid glands. Of these, 2 ones had cysts below the level of the clavicle. Cyst volume was 4.3-110.3 cm3 (24.1±26.2 cm3). High cystic parathyroid hormone (2012.5±946.7 pg/ml) was observed in all patients. Simple aspiration was performed in 5 patients, aspiration with sclerotherapy - in 10 patients, cystectomy - in 3 patients. Recurrence was diagnosed in 1 patient after aspiration and 2 patients after sclerotherapy. No pathognomonic clinical and ultrasonic symptoms, as well as specific cytological data lead to misdiagnosis. Analysis of PTH in non-functioning parathyroid cysts is essential for diagnosis. Minimally invasive treatment is preferable for true parathyroid cysts. However, these approaches are not radical.

Left parathyroid carcinoma with secondary hyperparathyroidism: a case report

BackgroundParathyroid carcinoma is a rare disease with a frequency of 0.005% of all malignancies [1, 2]. Various aspects of its pathogenesis, diagnosis, and treatment remain poorly understood. Furthermore, cases with secondary hyperparathyroidism are fewer. In this case report, we describe a case of left parathyroid carcinoma with secondary hyperparathyroidism.Case presentationThe patient was a 54-year-old woman who had been on hemodialysis since the age of 40 years. At 53 years of age, her calcium levels were high, and she was diagnosed with drug-resistant secondary hyperparathyroidism and was referred to our hospital for surgical treatment. Blood tests revealed calcium levels of 11.4 mg/dL and intact parathyroid hormone (PTH) levels of 1007 pg/mL. Neck ultrasonography revealed a 22-mm large round hypoechoic mass, partially indistinct margins, and D/W ratio > 1 at the left thyroid lobe. Computed tomography scans revealed a 20-mm nodule at the left thyroid lobe. No enlarged lymph nodes or distant metastases were noted. 99mTc-hexakis-2-methoxyisobutylisonitrile scintigraphy revealed an accumulation at the superior pole of the left thyroid lobe. Laryngeal endoscopy revealed paralysis of the left vocal cord, signifying recurrent nerve palsy due to parathyroid carcinoma. Based on these results, a diagnosis of secondary hyperparathyroidism and suspected left parathyroid carcinoma was made, and the patient underwent surgery. Pathology results revealed hyperplasia in the right upper and lower parathyroid glands. The left upper parathyroid gland showed capsular and venous invasion, and the diagnosis was left parathyroid carcinoma. At 4 months post-surgery, calcium levels improved to 8.7 mg/dL and intact PTH levels to 20 pg/mL, with no signs of recurrence.ConclusionsWe report a case of left parathyroid carcinoma associated with secondary hyperparathyroidism. Concomitant secondary hyperparathyroidism may cause mild hypercalcemia compared to parathyroid carcinoma alone due to the added modification of dialysis. Although our patient also presented with mild hypercalcemia, a D/W ratio > 1 on preoperative echocardiography and presence of recurrent nerve palsy on laryngoscopy led to the suspicion and treatment of parathyroid carcinoma preoperatively.

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization.

The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

Hyperparathyroidism: Pathological Diagnosis and Association with Parathyroid Localization.

The most comon patohistological finding in primary hyperparathyroidism is adenoma of the parathyroid gland, followed by hyperplasia and the rarest is carcinoma. However, hyperplasia of the parathyroid glands (PTG) is most commonly found in secondary and tertiary hyperparathyroidism. To determine the relationship between the localization of the parathyroid glands and pathological diagnosis, as well as the prevalence of individual pathological diagnosis after surgery in patients with hyperparathyroidism. Analysis of retrospective-prospective database of 79 patiens who underwent parathyreoidectomy for hyperparathyroidism in the 7-year study period. Diagnostic methods were used to identify enlarged parathyroid glands as well as to determine their localization: ultrasound examination, scintigraphy and operative finding. Standard hematoxylin eosin staining was used for pathohistological diagnosis. A correlation analysis between parathyroid gland localization and pathohistological diagnosis was performed. The median age of the patients were 51 age (range 20-73) and 67,1% of the patients were female. In the total number of surgically removed parathyroid glands (182), the most common pathohistological diagnosis was hyperplasia. Parathyroid adenoma was found in 21 cases. Other diagnoses (thyroid nodule / tissue, lymph node, thymus, cancer) were found in 11 cases, while a normal finding was found in 12 glands. Pathohistological diagnosis of hyperplasia and adenoma were more common in the lower parathyroid glands. Using the chi-square test, no association was found between pathohistological diagnosis and localization of enlarged parathyroid glands. The most common pathohistological diagnosis in hyperparathyroidism was hyperplasia and was most commonly found in the inferior parathyroid glands. Adenoma as pathohistological diagnosis is also most commonly found in the lower parathyroid glands, but without statistical significance.

Calcific uremic arteriolopathy in a young man on intermittent hemodialysis

A 42‐year‐old man with ESKD who has been on intermittent hemodialysis for 7 years, presented with extremely painful inguinal ulcer and abdominal mass. The lesion was developed 2 weeks after repairing aneurysmal cubital AVF. At first, it was a small and painful red nodule but then its size increased and a large ulcer was developed. In addition, the physical examination revealed a palpable and painful large mass at left lower side of abdominal wall. He did not have important risk factors such as diabetes mellitus, treatment with warfarin, and use of calcium containing phosphate binders, vitamin D or calcium supplements. The patient suffered a long standing and severe secondary hyperparathyroidism. The parathyroid hormone level was too high (3100 pg/ml). In addition, serum calcium and phosphorus levels were 9.4 mg/dl and 9.8 mg/dl respectively. The SPECT-CT scan with 99 m Tc-MIBI of parathyroid glands confirmed persistence of an adenoma in right lower parathyroid gland (Figure 1, green arrow). The BMI was 32 kg/m2. He had no adherence to use of phosphate binder or calcimimetic drugs. The radiological studies showed extensive microvascular calcification in soft tissues (Figure 1, small arrow) and osteitis fibrosa cystica in long bones (Figure 1, star). The patient underwent surgical debridement of ulcer and palpable abdominal mass, wound care, intensive dialysis therapy with low calcium dialysis bath, cinacalcet, sevelamer carbonate, antibiotic and analgesic therapy. The histological sample (H&E, 200X) shows Intramural calcification and obliteration of arteriole (large arrow) with extensive calcification in fat tissue (Figure 1, arrow head) which was consistent with Calcific Uremic Arteriolopathy (CUA). In addition to patient’s poor compliance to treatment of severe secondary hyperparathyroidism, the recent surgery of aneurismal AVF could also be an important trigger to development of calcific uremic arteriolopathy.

Thyroid Diseases

The thyroid plays a key role in normal metabolic and homeostatic processes, including thermomodulation, protein synthesis, carbohydrate and lipid metabolism, and modulation of adrenergic regulation. Surgical consultations are most often requested for control of hyperthyroidism or for treatment of euthyroid nodular disease. This review describes the approach to the patient with hyperthyroidism and with euthyroid nodular disease, including papillary, follicular, anaplastic, medullary, and primary thyroid cancer, and oncocytic (Hürthle cell) carcinoma. Operative techniques of thyroidectomy are described and include positioning, incisions-making, and troubleshooting. Postoperative care, including thyroid hormone management, is described. Complications and outcome evaluation are discussed. Tables list the etiologies of hyperthyroidism, benign and malignant etiologies of euthyroid nodular disease, familial syndromes of thyroid disease, the Bethesda classification of fine needle aspiration cytology and associated malignancy risk, the elements of common prognostic schemes for well-differentiated thyroid cancer, and the staging of differentiated, medullary, and anaplastic thyroid cancer. Figures show the six levels of cervical lymph nodes, the initial incision in a thyroidectomy, a midline incision, the superior pole vessels, the upper and lower parathyroid glands, the recurrent laryngeal nerve, and Delphian lymph nodes. An algorithm shows the approach to the patient with thyroid disease This review contains 7 figures, 8 tables, and 64 references.

Spontaneous rupture of the parathyroid adenoma with formation cervico-retrosternal cyst and massive hematoma: a case report

In this case report the authors inform about cervico-retrosternal cyst of the parathyroid gland, which develops as a result of spontaneous rupture of the adenoma and the formation of a hematoma with the development of neck compression syndrome. The patient was admitted to the clinic, a week after the onset of the disease, with complaints of dyspnea at rest, stridor breathing, weakness and mass formation of the right lateral region of the neck. There is no history of injuries, pathological fractures or invasive manipulations on the neck, indications of pathology of the thyroid or parathyroid glands. According to multispiral computed tomography, a volumetric fluid formation of the neck and upper mediastinum 63×57 mm in size with compression and narrowing of the trachea up to 5 mm was found. To clarify whether the formation belongs to the thyroid gland or the thyroid gland, a transcutaneous puncture was performed. The level of parathyroid hormone in the liquid is more than 2500 mg / ml, and in the blood — 304.9 pg / ml — parathyroid cyst. Using an increase in compression syndrome, removal of a cyst in a block with adenoma of the right lower parathyroid gland with achievement of remission of primary hyperparathyroidism. This clinical observation shows a rare course of parathyroid adenoma with rupture and hematoma formation, which led to the development of neck compression syndrome.

Persistence of secondary hyperparathyroidism after parathyroidectomy in a patient with chronic kidney disease: a case report

This is a clinical case of surgical treatment of persistence of secondary hyperparathyroidism (SHPT) in a patient with chronic kidney disease after previous parathyroidectomy. Programmed hemodialysis started in 2014, and in 2016 SHPT was diagnosed. In November 2018, indications for surgical treatment were presented in one of the clinics. According to scintigraphy, an increase in the functional activity of all four parathyroid glands (PTG) was observed, according to ultrasound data, the localization of the right lower, left upper and lower PTG was established. Removal of 3x PTG was performed without revision of the thymus horns (11.2018), while in the postoperative period, an adequate decrease in parathyroid hormone was not observed. After additional examination, according to ultrasound, scintigraphy and computer tomography of the neck with intravenous enhancement, it was found that both lower PTGs are located in the upper horns of the thymus. In July 2020, a repeated surgical intervention was performed in the volume of the right lower and left lower parathyroidectomy with a positive intraoperative test. Remission of SHPT was achieved. At present, no consensus has been reached on the extent of surgery for SHPT, since no statistically significant differences were found in the incidence of persistence / recurrence of SHPT. A complete assessment of the results of preoperative imaging techniques is required when planning surgery. Intraoperative monitoring of parathyroid hormone is an effective technique for assessing the radicality of surgical treatment.

Персистенция вторичного гиперпаратиреоза после ранее проведенной паратиреоидэктомии у пациентки с хронической болезнью почек: клинический случай

This is a clinical case of surgical treatment of persistence of secondary hyperparathyroidism (SHPT) in a patient with chronic kidney disease after previous parathyroidectomy. Programmed hemodialysis started in 2014, and in 2016 SHPT was diagnosed. In November 2018, indications for surgical treatment were presented in one of the clinics. According to scintigraphy, an increase in the functional activity of all four parathyroid glands (PTG) was observed, according to ultrasound data, the localization of the right lower, left upper and lower PTG was established. Removal of 3x PTG was performed without revision of the thymus horns (11.2018), while in the postoperative period, an adequate decrease in parathyroid hormone was not observed. After additional examination, according to ultrasound, scintigraphy and computer tomography of the neck with intravenous enhancement, it was found that both lower PTGs are located in the upper horns of the thymus. In July 2020, a repeated surgical intervention was performed in the volume of the right lower and left lower parathyroidectomy with a positive intraoperative test. Remission of SHPT was achieved. At present, no consensus has been reached on the extent of surgery for SHPT, since no statistically significant differences were found in the incidence of persistence / recurrence of SHPT. A complete assessment of the results of preoperative imaging techniques is required when planning surgery. Intraoperative monitoring of parathyroid hormone is an effective technique for assessing the radicality of surgical treatment.

Primary Hyperparathyroidism with a Predominant Lesion of the Gastrointestinal Tract

Primary hyperparathyroidism is a common pathology, but it is fact that doctors of various specialties run against difficulties in diagnosinging. The variety of clinical manifestations causes a long period of diagnosis and, late start of treatment. The main symptoms of this pathology are described taking into account the pathogenesis. The most common laboratory markers of hyperparathyroidism are incrising level of parathyroid hormone and hypercalcemia. Imaging examination methods are used to establish primary hyperparathyroidism. Targeted ultrasound examination of the parathyroid glands should be performed in all patients with suspected calcium metabolism disorders.This article presents a clinical case of primary hyperparathyroidism with predominant gastrointestinal symptoms. The patient was twice admitted to the hospital with various clinical manifestations of damage to the gastrointestinal tract. Erosive gastritis, terminal ileitis, chronic pancreatitis, and cholelithiasis were identified. A differential diagnosis was made with small intestine lymphoma and Crohn’s disease. In addition, there were General cerebral symptoms in the form of lethargy, rapid exhaustion. Due to severe electrolyte disorders, the patient was observed in the intensive care unit. Due to the development of mechanical jaundice, endoscopic retrograde cholangiopancreatography with papillosphincterotomy was performed. Based on hypercalcemia, elevated parathyroid hormone levels, and visualization of parathyroid gland formation, the diagnosis of primary hyperparathyroidism was established based on ultrasound data. An adenomectomy of the left lower parathyroid gland was performed. in the surgical department. The patient was discharged with positive dynamics in the form of improvement in General health, cessation of pain, regress of vomiting, expansion of motor activity. Betimes diagnosis and treatment of primary hyperparathyroidism, on the example of the described case, leads to complete relief of symptoms and improvement of the quality of life of patients.

FETAL ANATOMY OF PARATHYROID GLANDS

The aim: To study the forms of anatomical variability of the external structure of the upper and lower parathyroid glands in the fetal period of human ontogenesis. Materials and methods: The study involved 48 specimens of human fetuses with 81,0-375,0 mm of crown-rump length (CRL). The study was conducted by means of macromicroscopic preparation, morphometry and variation statistics method. Results: The age and individual anatomical variability, complex way of development and formation of synotopic embryotropographic correlations of the upper and lower parathyroid glands in the prenatal period of human ontogenesis create numerous prerequisites for the emergence of variants of their external structure and topography in the fetuses of both different and the same age groups. Conclusions: There is a significant anatomical variability of the upper and lower parathyroid glands in 4-10-month-old fetuses, which is manifested by varieties of their shape and topical location. Aplasia of the upper parathyroid glands, which was found in two human fetuses aged 7 months, was due to the fetures of their organogenesis and the formation of syntopy in the embryonic and prefetal periods of their development. Parathyroid glands are mainly supplied with blood by the branches of the inferior thyroid artery. The branches of the upper thyroid artery and the arteries of adjacent organs: larynx, trachea and esophagus are involved in the blood supply. The right and left inferior thyroid veins are tributaries of the corresponding brachiocephalic vein, paired (right and left) superior and middle thyroid veins are those for the internal jugular vein.

Ultrasonic characteristics of normal parathyroid glands and their clinical significances

Objective To investigate the location, size, ultrasonic characteristics and clinical significances of normal parathyroid glands. Methods A total of 350 healthy subjects with no relevant diseases in Shanxi Provincial Cancer Hospital from January 2017 to December 2017 were selected. The age ranged from 9 to 83 years old. They were divided into seven groups according to age, with 50 in each group. The position, size, shape, echo, boundary, and blood flow signal characteristics of the normal parathyroid glands in these healthy subjects examined by ultrasound were retrospectively analyzed, and the differences among the different groups were compared. Results The detection rate of normal parathyroid glands in 350 subjects was 95.4% (1 335/1 400). The normal parathyroid glands were oval, fusiform or irregular shape hyperechoic or isoechoic nodules, with homogeneous echoes and clear borders. There was no obvious blood flow signal in most glands. The proportion of fusiform shape in upper parathyroid glands (24.4%, 161/659) was higher than that in lower parathyroid glands (18.4%, 125/676), the difference was statistically significant (χ2 = 6.99, P 0.05). Conclusions The detection rate of normal parathyroid glands is high, and they mainly located in the upper and lower thyroid regions within 2 cm from the lower margin of the thyroid. Ultrasound images are mainly characterized by the clear elliptical shape and the uniform high echo. The ultrasonic characteristics of normal parathyroid glands are conducive to preoperative localization of parathyroid glands and provides a reliable basis for finding and retaining parathyroid glands in thyroid surgery. Key words: Parathyroid glands; Ultrasonography

Pre-operative Localisation of the Parathyroid Glands in Secondary Hyperparathyroidism: A Retrospective Cohort Study

Complete parathyroidectomy (PTx) is essential during total PTx for secondary hyperparathyroidism (SHPT) to prevent recurrent and persistent hyperparathyroidism. Pre-operative imaging evaluations, including computed tomography (CT), ultrasonography (US), and Tc-99m sestamibi (MIBI) scans, are commonly performed. Between June 2009 and January 2016, 291 patients underwent PTx for SHPT after pre-operative evaluations involving CT, US, and MIBI scans, and the diagnostic accuracies of these imaging modalities for identifying the parathyroid glands were evaluated in 177 patients whose intact parathyroid hormone (PTH) levels were <9 pg/mL after the initial PTx. Additional PTx procedures were performed on 7 of 114 patients whose intact PTH levels were >9 ng/mL after PTx, and the diagnostic validities of the imaging modalities for the remnant parathyroid glands were evaluated. A combination of CT, US, and MIBI scans achieved the highest diagnostic accuracy (75%) for locating bilateral upper and lower parathyroid glands before initial PTx. The accuracies of CT, US, and MIBI scans with respect to locating remnant parathyroid glands before additional PTx were 100%, 28.6%, and 100%, respectively. A combination of CT, US, and MIBI scans is useful for initial PTx for SHPT, and CT and MIBI scans are useful imaging modalities for additional PTx procedures.

CLINICAL CASE OF GIANT ADENOMA OF PARATHYROID GLAND

Objective: to analyse and provide a description of the clinical case of a giant parathyroid adenoma, to show the fetures of clinical course, diagnosis, the results of surgical treatment and tactics of conducting in the postoperative period. Materials and methods. Patient S., aged 60, with a 10-year history of severe osteoporosis with fractures, urolithiasis, hypertension, low back pain, was consulted by a rheumatologist. In respect that there was the combination of severe osteoporosis with nephrolithiasis and elevated serum calcium level, the patient was directed to a consultation with the endocrinologist and was hospitalized in the city endocrinology department. Results. When examining in the endocrinology department, violations of phosphorus-calcium metabolism, an increase in parathyroid hormone, characteristic of hyperparathyroidism of bone skeleton changes were revealed. Based on the results of ultrasound and magnetic resonance imaging of the neck, neoplasm of the lower parathyroid gland was revealed on the left side. A puncture biopsy and surgical treatment was performed. A dense tumor of dark color, 45 × 30 × 20 mm in size, was removed, according to a histological study – a mixed-cell adenoma with cellular polymorphism. The early postoperative period was complicated by the development of hypoparathyroidism that was corrected by taking calcium and cholecalciferol preparations. In the future, the condition stabilized, a partial regression of the symptoms of hyperparathyroidism was observed. Сonclusion. In this clinical case, features of the clinical course of parathyroid adenoma of large size, the role of interdisciplinary interaction in diagnosis, the results of surgical treatment and the difficulties of postoperative management are presented.

Osteolytic lesions (brown tumors) of primary hyperparathyroidism misdiagnosed as multifocal giant cell tumor of the distal ulna and radius: a case report

BackgroundBrown tumors represent a rare clinical manifestation reported in approximately 3% of patients with primary hyperparathyroidism and correspond to radiologically osteolytic lesions with well-defined borders in different parts of the skeleton.Case presentationWe report the case of a 53-year-old white man who presented to our hospital with osteolytic lesions of his distal ulna and radius, causing pain and swelling of 2-month duration. A subsequent biopsy revealed histological features consistent with giant cell tumor and a complete resection of his distal ulna was followed, along with curettage and cementoplasty of the distal radial metaphysis. Two weeks later, he was re-admitted with diffuse musculoskeletal soreness, anorexia, constipation, nausea, and localized abdominal pain and multiple osteolytic lesions on plain radiographs. A histopathological examination of the ulna and radius specimens showed similar findings and, given the multifocality, brown tumors related to primary or secondary hyperparathyroidism was included in the differential diagnosis. A laboratory examination showed high total serum calcium (14.5 mg/dl) and low serum phosphorus and 25-hydroxyvitamin D levels. Primary hyperparathyroidism was suspected and confirmed by the elevated parathyroid hormone levels of 1453 pg/mL. At radiological work-up, using computed tomography, ultrasonography, and parathyroid subtraction technetium-99m sestamibi scintigraphy, a 4.5 × 2.5 × 3.2 cm mass emanating from the right lobe of his thyroid gland was detected, displaying extensive uptake in the right lower parathyroid gland. After appropriate medical support including hyperhydration and high doses of diuretics and diphosphonates, his laboratory profile normalized and he underwent total thyroidectomy with removal of the parathyroid glands. Our patient is now recovering 12 months after surgery, with normal values of serum parathyroid hormone and calcium levels. The lytic bone lesions have almost disappeared and no other additional orthopedic intervention was necessary.ConclusionsThe present case report emphasizes the need of inclusion of brown tumors in the differential diagnosis of multifocal osteolytic bone lesions, in order to avoid harmful surgical interventions. Laboratory testing of serum phosphate, calcium levels, and parathyroid hormone levels should always be included in the routine survey of patients with multifocal osteolytic lesions.

BONE SEVERE FORM OF HYPERPARATHYROIDISM IN A PATIENT WITH ADENOMA OF PARATHYROID GLAND

Hyperparathyroidism is one of the most common endocrinopathies. This disease leads to a violation of phosphorus-calcium metabolism and the washing out of calcium from bone tissue. Breach of the skeleton’s structure in hyperparathyroidism is often mistaken for metastatic bone damage, which leads to incorrect treatment tactics. In this work we present the clinical observation of a patient with an adenoma of the parathyroid gland and a severe bone form of hyperparathyroidism. Multiple lesions of bones with destruction of the cortical layer and the presence of the softtissue component were initially regarded as metastases in the bone. However, the morphological pattern of bone foci, as well as an elevated level of calcium and parathyroid hormone, made it possible to diagnose the bony form of hyperparathyroidism. The search for the cause of hyperparathyroidism revealed a tumor in the projection of the right lower parathyroid gland. Surgical removal of parathyroid adenoma led to the normalization of the level of calcium and parathyroid hormone. The article presents data of laboratory-instrumental methods of research and the results of surgical treatment of a patient.

Iatrogenic hypoparathyroidism after surgery for retrosternal goitre. A single centre retrospective analysis.

The aim of this study is to assess, retrospectively, the incidence of secondary hypoparathyroidism after total thyroidectomy in patients with retrosternal goitre. From January 2009 to September 2015, 622 patients who undergone total thyroidectomy for goitre, were retrospectively observed. The patients were divided into two group: Group A, including 58 patients with retrosternal goitre and Group B, including 562 patients with in situ goitre. Those patients with diseases of the parathyroid glands, assumption of drugs modifying calcium metabolism and who received blood transfusions before or after surgery, were excluded from the study. In both groups, a total thyroidectomy was performed under general anaesthesia. The upper and lower parathyroid glands in both groups were observed in situ as well. All surgical specimens underwent histological examination. Transient hypocalcaemia was observed in a higher percentage in group A (15% vs 7%, P <0.05). The mean hospital stay was greater in group A (P <0.05). There were no statistically differences between the two groups in terms of permanent hypocalcaemia and post-operative blood ionized calcium (72hours and 1 month). Many efforts should be made to respect parathyroids during total thyroidectomy in retrosternal goitre; greater attention should be given to inferior parathyroid glands that should be displayed, respecting the vasculature and performing a terminal lower thyroid artery ligation in order to reduce the risk of transient hypocalcaemia and - as a consequence - the average hospital stay.

The Parathyroids

Successful surgery of the parathyroid glands depends on a thorough knowledge of their anatomic and developmental relations. This knowledge is crucial for locating ectopic parathyroids or preventing injury to the recurrent laryngeal nerve. In addition, the surgeon should understand the physiology and function of these glands. Unlike other conditions a surgeon might treat, physiology, and not anatomy alone, often dictates the timing and course of parathyroid procedures. This surgeon-oriented, focused review covers the development, histology, anatomy, physiology, and pathophysiology of the parathyroid. Figures show the location and frequencies of ectopic upper and lower parathyroid glands, and regulation of calcium homeostasis. This review contains 2 highly rendered figures, and 16 references Key words: calcitonin; hypercalcemia; hyperparathyroidism; multiple endocrine neoplasia; parathyroid; parathyroid hormone; primary hyperparathyroidism; secondary hyperparathyroidism; tertiary hyperparathyroidism

The Parathyroids

Successful surgery of the parathyroid glands depends on a thorough knowledge of their anatomic and developmental relations. This knowledge is crucial for locating ectopic parathyroids or preventing injury to the recurrent laryngeal nerve. In addition, the surgeon should understand the physiology and function of these glands. Unlike other conditions a surgeon might treat, physiology, and not anatomy alone, often dictates the timing and course of parathyroid procedures. This surgeon-oriented, focused review covers the development, histology, anatomy, physiology, and pathophysiology of the parathyroid. Figures show the location and frequencies of ectopic upper and lower parathyroid glands, and regulation of calcium homeostasis. This review contains 2 highly rendered figures, and 16 references Key words: calcitonin; hypercalcemia; hyperparathyroidism; multiple endocrine neoplasia; parathyroid; parathyroid hormone; primary hyperparathyroidism; secondary hyperparathyroidism; tertiary hyperparathyroidism

Prospective comparison of high resolution ultrasonography with technetium sestamibi scintigraphy and operative findings in detection of abnormally hyper functioning parathyroid gland/glands in primary hyperparathyroidism

Background:Ultrasonography is cheap, easily available and convenient modality of diagnosis.Methods: We prospectively studied 61 patients with PHPT. Patients preoperatively underwent USG neck and MIBI scan, results were interpreted independently and compaired with intra operative findings.Results:61 patients who underwent parathyroidectomy for PHPT were studied. Ultrasonography neck showed correct side in 46/51 (90%) and correct site in 32/51 (63%) patients with single parathyroid adenomas. MIBI scan showed correct side and site of parathyroid adenoma in 46/50 (92%) and 43/50 (86%) patients respectively. Patients with double adenomas USG neck showed positive results in all 5 patient with 100% sensitivity where as MIBI scan showed positive results in four out of five patients (80%). 1 patient with four gland hyperplasia USG picked three out of four enlarged glands while as MIBI scan not picked any of the enlarged glands. Operative findings revealed that right lower parathyroid gland was the most common gland involved (54%) followed by left lower (29%), right upper (6.6%), left upper (0%) and multiple / bilateral (9.6%).Conclusions:USG is an affordable, conventional and useful tool in detecting enlarged parathyroid glands in most of the patients with PHPT, but operator dependant. However, when USG can’t detect enlarged parathyroid gland 99mTc-MIBI Scan is complimentary to it.