Parathyroid Research Articles

Paraneoplastic hypercalcemia in a canine patient with a mandibular salivary carcinoma.

To describe a novel presentation of paraneoplastic hypercalcemia caused by a canine salivary carcinoma. A 6-year-old intact male Husky with hypercalcemia and a spontaneous salivary carcinoma, stage III. The dog presented with polyuria, polydipsia, and hypercalcemia. Physical examination revealed a 37 X 43-mm firm mass in the ventrolateral aspect of the right-hand side of the neck, caudal to the temporomandibular joint. Incisional biopsy was suspicious of metastatic carcinoma to the mandibular lymph node. A full-body CT scan found a large, heterogenous, contrast-enhancing mass on the right ventrolateral neck that appeared to be originating from either the mandibular lymph node or right mandibular salivary gland. Parathyroid hormone-related protein was considered within normal reference intervals, and both parathyroid glands appeared ultrasonographically normal. The patient was treated with a marginal surgical excision of the mass, without immediate complications. Histopathology confirmed the presence of a salivary carcinoma with narrow margins of excision and invasion of the mandibular lymph node. Twenty-four hours after surgery, ionized calcium returned to normal reference values and clinical signs completely resolved. Hypercalcemia is an urgent pathology with important systemic implications requiring prompt diagnosis and intervention. In this case report, we identify the first salivary carcinoma associated with a paraneoplastic hypercalcemia, including this pathology as a new differential diagnosis. The hypercalcemia resolved with marginal surgical excision, but interestingly the parathyroid hormone-related protein was not overexpressed, meaning that this neoplasia could mediate hypercalcemia by another pathophysiological mechanism.

Infiltration of nanocarbon into the trachea during thyroidectomy surgery: case series and literature review.

The presence of metastatic disease in the cervical lymph nodes can affect the recurrence and survival of patients with thyroid cancer. Parathyroid gland injury during surgery can result in hypoparathyroidism, particularly with total thyroidectomy. Injection of carbon nanoparticles into the thyroid will label draining lymph nodes and aid in the visualization of metastatic cervical lymph nodes during a radical operation, sparing accidental damage to the parathyroid glands. Although reported to be useful during surgery, the safety of nanocarbon particles has rarely been investigated, and adverse side effects need to be studied. The author describes five patients with thyroid cancer who had carbon secretions in the trachea or mucosa after carbon nanoparticles were injected into the thyroid. A patient with carbon secretions in the trachea mucosa recovered but had progressive dyspnoea. Surgical treatment was performed, and a mass was found in the trachea mucosa. After excluding all other possibilities, the author concluded that the mass was caused by nanocarbon suspension. To the author's knowledge, there are no reports on nanocarbon suspension into the mucosa and no consensus has yet been reached on the precise injection site, depth, or dose for injecting carbon nanoparticles before thyroidectomy. The author suggests that the most appropriate injection depth of nanocarbon suspensions should be no more than 3mm of the thyroid gland thickness to avoid deep injection into the trachea.

Chronic Kidney Disease-associated Lung Injury Is Mediated by Phosphate-induced MAPK/AKT Signaling.

Chronic kidney disease (CKD) is associated with systemic phosphate elevations, called hyperphosphatemia. Translational studies have shown that hyperphosphatemia contributes to CKD-associated inflammation and injury in various tissues, including the kidney, heart, liver, and parathyroid gland. Mechanisms underlying pathologic actions of elevated phosphate on cells are not well understood but seem to involve uptake of phosphate through sodium-phosphate cotransporters and phosphate-induced signaling via fibroblast growth factor receptor (FGFR) 1. Clinical studies indicate CKD patients are more likely to develop inflammatory and restrictive lung diseases, such as fibrotic interstitial lung diseases, and here we aimed to determine whether hyperphosphatemia can cause lung injury. We found that a mouse model of CKD and hyperphosphatemia, induced by an adenine-rich diet, develops lung fibrosis and inflammation. Elevation of systemic phosphate levels by administration of a high-phosphate diet in a mouse model of primary lung inflammation and fibrosis, induced by bleomycin, exacerbated lung injury in the absence of kidney damage. Our in vitro studies identified increases of proinflammatory cytokines in human lung fibroblasts exposed to phosphate elevations. Phosphate activated extracellular signal related kinase (ERK) 1/2 and protein kinase B (PKB/AKT) signaling, and pharmacological inhibition of ERK, AKT, FGFR1, or sodium-phosphate cotransporters prevented phosphate-induced proinflammatory cytokine upregulation. Additionally, inhibition of FGFR1 or sodium-phosphate cotransporters decreased the phosphate-induced activation of ERK and AKT. Our study suggests that phosphate can directly target lung fibroblasts and induce an inflammatory response and that hyperphosphatemia in CKD and non-CKD models contributes to lung injury. Phosphate-lowering strategies might protect from CKD-associated lung injury.

Video-Assisted Thoracoscopic Surgery Is a Safe and Feasible Technique for Mediastinal Parathyroid Lesions.

Introduction: Hyperfunctional ectopic parathyroid glands in the mediastinum pose a challenge to diagnosis and require optimal surgical management. Video-assisted thoracoscopic surgery (VATS) has emerged as a promising minimally invasive approach, offering potential benefits in terms of both patient comfort and oncological principles. This study aimed to evaluate the effectiveness and safety of VATS for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum. Methods: Among the 538 patients with mediastinal tumors who underwent thoracoscopic surgery at Istanbul University (2008-2021), 11 exhibited hyperfunctional ectopic parathyroid glands. The localization of the glands was performed using various diagnostic techniques, including neck ultrasound, sestamibi scan, CT (computerized tomography), and SPECT (Single-photon emission computed tomography). VATS (Video-assisted thoracoscopic surgery) was used to remove ectopic parathyroid glands in all 11 patients, with no need for conversion to open surgery. Results: The pathological results showed that VATS successfully removed the ectopic glands in all 11 patients. Serum parathyroid hormone (PTH) levels were monitored intraoperatively, and frozen sections were used to confirm the presence of parathyroid adenomas in all cases. Postoperative analysis showed that PTH levels dropped by at least 50% within 10-15 minutes after adenoma removal. Conclusion: VATS is a safe and effective method for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum with a low risk of complications.

Prevalence and Associated Factors of Osteoporosis Among People With Hypertension in Alahsa, Saudi Arabia: A Cross-Sectional Study.

Introduction Osteoporosis (OP) and hypertension (HTN) are prevalent conditions impacting elderly health. This study aimed to explore the prevalence and factors associated with OP among people with HTN in Al-Ahsa, Saudi Arabia (2023). Material and method A cross-sectional analytical study was conducted. Adults aged 50-79 diagnosed with HTN were recruited from those referred for dual-energy X-ray absorptiometry (DEXA) scans using a systematic random sampling method. The participants' electronic health records were reviewed and all participants were interviewed using a structured questionnaire to collect data not available in the electronic health records related to demographics, medical history, and lifestyle factors. Chi-square tests and multivariable logistic regression were used to assess the associations between OP and clinical parameters. Results A total of 255 participants were recruited, with 115 (45.1%) having normal bone density, 97 (38%) having osteopenia, and 43 (16.9%) having OP. Females 167 (65.5%) were higher than males 88 (34.5%). The average age of all the respondents was 66.2 ± 7.96 years, and their average body mass index (BMI) was 22.2 ± 15.1. The age in years (mean ± SD) of participants with OP 68.04 ± 7.60 was higher compared to normal 64.9 ± 7.46 (p-value = 0.03). Factors that appear to increase the risk of OP in multivariable logistic regression analysis with an adjusted odds ratio (OR) (95% CI) include increased age (OR: 1.17, CI: 0.9-1.2, p-value = 0.048), and parathyroid gland disorder comorbidity (OR: 15.1, CI: 0.7-32, p-value = 0.03), while some factors that reduce the risk of developing OP include increased BMI (OR: 0.9, CI: 0.91-1.03, p-value = 0.03), literate individuals (OR: 0.1, CI: 0.01-1.4, p-value = 0.046), and taking beta-blockers (BB) treatment (OR: 0.23, CI: 0.01-1.3, p-value = 0.02) reduced odds of developing OP according to results. Conclusion The OP is notably present among people with HTN, especially older people, and parathyroid gland disorders. Higher BMI levels, along with the use of BB, help to decrease it. Additionally, any level of education above illiteracy is associated with a lower prevalence of OP, suggesting that education may have a protective effect against OP in HTN patients. We recommend further research on OP risk factors in HTN Saudi patients. Future research should focus on assessing the impact of educational levels and socioeconomic factors on OP prevalence and investigating the association between specific comorbidities (e.g., diabetes mellitus (DM) and parathyroid gland disorders) and OP risk in HTN individuals. Collaborate with public health authorities and organizations to integrate OP screening into routine HTN patient care protocols.

Comparison of thyroid surgery techniques: a retrospective cohort study and meta-analysis of traditional electric knife vs. straight bipolar electrocoagulation forceps.

In recent years, advancements in surgical techniques for thyroidectomy have led to varying outcomes and efficiencies. Understanding these differences is crucial to optimize patient care and surgical success. This study compared intra- and postoperative parameters of thyroid surgery for thyroidectomy or thyroid cancer. One approach involved the traditional electric knife, employing traditional clamp-ligation skills and an electric knife. The other approach utilized straight bipolar electrocoagulation forceps for micro-hemostasis and micro-cutting. Data were analyzed retrospectively for 228 patients who underwent thyroidectomy at the Third Affiliated Hospital of Kunming Medical University from January 2014 to November 2018. Surgery was performed either as traditional open surgery (n=150) or as a meticulous anatomical procedure involving bipolar electrocoagulation (n=78). In addition, data from published studies comparing the two surgical procedures were meta-analyzed. The bipolar electrocoagulation procedure was associated with significantly shorter total operation time, lower intraoperative blood loss and lower rate of hypocalcemia. The two procedures were associated with similar rates of hoarseness. Meta-analysis of eight studies involving 2,080 patients showed that bipolar electrocoagulation was associated with significantly shorter total operation time than the traditional approach (mean difference =-21.29 min, 95% CI: -26.32 to -16.27) and with less intraoperative bleeding (mean difference =-12.87 min, 95% CI: -23.81 to -1.93). Straight bipolar electrocoagulation forceps can be used to perform fine dissection during thyroid surgery. Performing "micro-hemostasis" and "micro-cutting" manipulations with these straight bipolar forceps can smoothly dissect nerves and parathyroid glands and may reduce intraoperative bleeding, operation time and rates of postoperative complications, might accelerate recovery after surgery.

Development and Validation of an Explainable Machine Learning Model for Identification of Hyper-Functioning Parathyroid Glands from High-Frequency Ultrasonographic Images

ObjectiveTo develop and validate a machine learning (ML) model based on high-frequency ultrasound (HFUS) images with the aim to identify the functional status of parathyroid glands (PTGs) in secondary hyper-parathyroidism (SHPT) patients. MethodsThis retrospective study enrolled 60 SHPT patients (27 female, 33 male; mean age: 51.2 years) with 184 PTGs detected from February 2016 to June 2022. All enrollments underwent single-photon emission computed tomography/computed tomography and contrast-enhanced ultrasound examinations. The PTGs were randomly divided into training (n = 147) and testing datasets (n = 37). Four effective ML classifiers were used and combined models incorporating multi-modal HFUS visual signs and radiomics features was constructed based on the optimal classifier. Model performance was compared in terms of discrimination, calibration and clinical utility. The Shapley additive explanation method was used to explain and visualize the main predictors of the optimal model. ResultsThis model, using a random forest classifier algorithm, outperformed other classifiers. Based on optimal classifier features, the model constructed from ultrasound visual and ML features achieved a favorable performance in the prediction of hyper-functioning PTGs. Compared with the traditional visual model, the ultrasound-based ML model achieved significant (p = 0.03) improvement (area under the curve: 0.859 vs. 0.629) and higher sensitivity (100.0% vs. 94.1%) and accuracy (86.5% vs. 67.6%). Among the predictors attributed to model development, large size and high echogenic heterogeneity of PTGs in ultrasonographic images were more often associated with high risk of hyper-functioning PTGs. ConclusionThe ultrasound-based ML model for identifying hyper-functioning PTGs in SHPT patients showed good performance and interpretability using high-frequency ultrasonographic images, which may facilitate clinical management.

Incidental synchronous intrathyroidal parathyroid carcinomas and papillary thyroid microcarcinoma with compressive neck mass and primary hyperparathyroidism: case report and literature review

BackgroundParathyroid carcinoma (PC) is a rare malignancy, often diagnosed incidentally through postoperative pathological examination. The occurrence of nodular goiter, intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma (PA), and papillary thyroid microcarcinoma (PTMC) is extremely uncommon, which prompted us to report our case experience.Case presentationWe describe a 67-year-old male who presented with a cervical mass causing tracheal compression, which prompted him to seek medical advice. Based on preoperative auxiliary examination results from color Doppler ultrasound, SPECT parathyroid imaging, and blood tests, he was initially diagnosed with a suspected parathyroid adenoma and nodular goiter. Excision of the right lobe and isthmus of the thyroid, and left superior parathyroid gland was conducted, which were sent to intraoperative frozen pathological examination. During intraoperative observation, adhesion around the right thyroid lobe was discovered. Consequently, right central area lymph node dissection was performed due to suspicion of an aggressive malignant tumor. Histology and immunohistochemistry analysis revealed incidental intrathyroidal parathyroid carcinoma, contralateral parathyroid adenoma, classical papillary thyroid microcarcinoma, and nodular goiter.ConclusionParathyroid carcinoma should be highly suspected when extremely high levels of PTH and severe hypercalcemia are present, which cannot be simply explained by a preoperatively localized parathyroid adenoma, especially when suspicious malignant adhesion is found during intraoperative exploration. In cases where multifocal thyroid nodules are associated with increased uptake of 99Tc-sestamibi, the possibility of coexisting carcinomas should be considered, not only for thyroid malignancy but also for the potential presence of intrathyroidal parathyroid carcinoma.

Is intraoperative parathyroid monitoring during minimally invasive parathyroidectomy still justified?

Primary hyperparathyroidism (PHPT) is the third most common endocrine disease. With parathyroidectomy, a cure rate of over 95% at initial surgery is reported. Localization of the abnormal parathyroid gland is critical for the operation to be successful. The aim of this study is to analyze data of patients with single gland disease (SGD) and positive concordant localization imaging undergoing minimally invasive parathyroidectomy (MIP) and intraoperative parathyroid hormone monitoring (IOPTH) to evaluate if IOPTH is still justified in patients with localized SGD. A retrospective database analysis of all minimally invasive operations with IOPTH for PHPT and positive concordant localization in ultrasound (US) and 99mTc-sestamibi scintigraphy (MIBI) between 2016-2021. When both US and MIBI were negative, patients underwent either choline or methionine PET-CT. The patients were also analyzed a second time without applying IOPTH. In total, 198 patients were included in the study. The sensitivity of US, MIBI and PET-CT was 96%, 94% and 100%, respectively. Positive predictive value was 88%, 89% and 94% with US, MIBI and PET-CT, respectively. IOPTH was true positive in 185 (93.4%) patients. In 13 (6.6%) patients, no adequate IOPTH decline was observed after localizing and extirpating the assumed enlarged parathyroid gland. Without IOPTH, the cure rate decreased from 195 (98.5%) to 182 (92%) patients and the rate of persisting disease increased from 2 (1.0%) to 15 (7.5%) patients. Discontinuing IOPTH significantly increases the persistence rate by a factor of 7.5 in patients with concordantly localized adenoma. Therefore, IOPTH appears to remain necessary even for this group of patients.

Intrathyroidal Parathyroid Adenoma - An Incidental Diagnosis.

Aim This case report highlights the importance of preoperative assessment of calcium in all cases of thyroid surgery. Intrathyroidal parathyroid adenoma (IPA) is a rare presentation of primary hyperparathyroidism. It is caused by abnormal embryonic migration of parathyroid glands and is difficult to detect preoperatively. When diagnosed pre operatively it has good surgical outcome. Herein authors present a case of thirty-two-year lady who underwent hemithyroidectomy for colloid goitre and was detected to have intrathyroidal parathyroid adenoma (IPA) on histopathological examination.

Review of clinical practice guidelines for hypoparathyroidism

Hypoparathyroidism is an endocrine disease characterized by reduced production of parathyroid hormone by the parathyroid glands or tissue resistance to its action. This is accompanied by disturbances in phosphorus-calcium metabolism.The main cause of hypoparathyroidism is damage or removal of the parathyroid glands during surgery on the neck organs. Autoimmune hypoparathyroidism is the second most common form of the disease, which occurs, as a rule, within the autoimmune polyglandular syndrome type 1.The development of chronic hypoparathyroidism of any etiology requires lifelong appointment of multicomponent therapy, as well as careful monitoring and an individual approach. In the absence of adequate dynamic monitoring, multiple complications develop from vital organs, in particular calcification of the urinary system, soft tissues and the brain; cardiovascular pathology; visual disturbances; muscle and bone diseases leading to decreased quality of life of patients.Thus, timely diagnosis, rationally selected drug therapy and competent patient management will reduce the risks of complications, improve the prognosis, and reduce the frequency of hospitalizations and disability of patients with chronic hypoparathyroidism.The article presents the main recommendations of the new project of clinical guidelines for patients with hypoparathyroidism, approved by the Ministry of Health of the Russian Federation in 2021. They include the algorithms of diagnosis, treatment and dynamic monitoring of hypoparathyroidism, as well as management of postsurgical hypocalcemia and medical care of and the disease during pregnancy.

Imaging Recommendations for Diagnosis and Management of Primary Parathyroid Pathologies: A Comprehensive Review.

Parathyroid pathologies are suspected based on the biochemical alterations and clinical manifestations, and the predominant roles of imaging in primary hyperparathyroidism are localisation of tumour within parathyroid glands, surgical planning, and to look for any ectopic parathyroid tissue in the setting of recurrent disease. This article provides a comprehensive review of embryology and anatomical variations of parathyroid glands and their clinical relevance, surgical anatomy of parathyroid glands, differentiation between multiglandular parathyroid disease, solitary adenoma, atypical parathyroid tumour, and parathyroid carcinoma. The roles, advantages and limitations of ultrasound, four-dimensional computed tomography (4DCT), radiolabelled technetium-99 (99mTc) sestamibi or dual tracer 99mTc pertechnetate and 99mTc-sestamibi with or without single photon emission computed tomography (SPECT) or SPECT/CT, dynamic enhanced magnetic resonance imaging (4DMRI), and fluoro-choline positron emission tomography (18F-FCH PET) or [11C] Methionine (11C -MET) PET in the management of parathyroid lesions have been extensively discussed in this article. The role of fluorodeoxyglucose PET (FDG-PET) has also been elucidated in this article. Management guidelines for parathyroid carcinoma proposed by the American Society of Clinical Oncology (ASCO) have also been described. An algorithm for management of parathyroid lesions has been provided at the end to serve as a quick reference guide for radiologists, clinicians and surgeons.

Near-Infrared Autofluorescence Signature: A New Parameter for Intraoperative Assessment of Parathyroid Glands in Primary Hyperparathyroidism.

The success of parathyroidectomy in primary hyperparathyroidism depends on the intraoperative differentiation of diseased from normal glands. Deep learning can potentially be applied to digitalize this subjective interpretation process that relies heavily on surgeon expertise. In this study, we aimed to investigate whether diseased versus normal parathyroid glands have different near-infrared autofluorescence (NIRAF) signatures and whether related deep learning models can predict normal versus diseased parathyroid glands based on intraoperative in-vivo images. This prospective study included patients who underwent parathyroidectomy for primary hyperparathyroidism or thyroidectomy using intraoperative NIRAF imaging at a single tertiary referral center from November 2019 to March 2024. Autofluorescence intensity and heterogeneity index of normal versus diseased parathyroid glands were compared, and a deep learning model was developed. NIRAF images of a total of 1,506 normal and 597 diseased parathyroid glands from 797 patients were analyzed. Normal versus diseased glands exhibited a higher median normalized NIRAF intensity [2.68 (2.19-3.23) vs 2.09 (1.68-2.56) pixels, p<.0001] and lower heterogeneity index [0.11 (0.08-0.15) vs 0.18 (0.13-0.23), p<.0001]. On receiver operating characteristics analysis, optimal thresholds to predict a diseased gland were 2.22 in pixel intensity and 0.14 in heterogeneity index. On deep learning, precision and recall of the model were 83.3% each, and area under the precision-recall curve (AUPRC) was 0.908. Normal and diseased parathyroid glands in primary hyperparathyroidism have different intraoperative NIRAF patterns that could be quantified with intensity and heterogeneity analyses. Visual deep learning models relying on these NIRAF signatures could be built to assist surgeons in differentiating normal from diseased parathyroid glands.

Activation of the Calcium-Sensing Receptor by a Subfraction of Amino Acids Contained in Thyroid Drainage Fluid.

Hypoparathyroidism is a common sequela of thyroid surgery; in this study, we aimed at exploring the pathogenesis behind it. The following premises suggest that wound fluid might be a causative agent. (i) Parathyroid hormone secretion is under feedback control by the calcium-sensing receptor, which responds to a diverse array of activating ligands. (ii) Postoperative hypoparathyroidism arises from a secretory deficiency of the parathyroid glands. Even in patients later unaffected by hypoparathyroidism, parathyroid hormone levels drop within hours after surgery. (iii) Wound fluid is bound to enter the tissue around the thyroid bed, where the parathyroid glands are located. Its composition is shaped by a series of proteolytic reactions triggered by wounding. Using thyroid drainage as a surrogate, we addressed the possibility that wound fluid contains compounds activating the calcium-sensing receptor. Drainage fluid ultrafiltrate was found to be rich in amino acids, and on separation by HPLC, compounds activating the calcium-sensing receptor partitioned with hydrophilic matter that rendered buffer acidic. The data show that glutamate and aspartate at millimolar concentrations supported activation of the calcium-sensing receptor, an effect contingent on low pH. In the presence of glutamate/aspartate, protons activated the calcium-sensing receptor with a pH50 of 6.1, and at pH 5, produced maximal activation. This synergistic mode of action was exclusive; glutamine/asparagine did not substitute for the acidic amino acids, nor did Ca2+ substitute for protons. NPS-2143, a negative allosteric receptor modulator completely blocked receptor activation by glutamate/aspartate and by fractionated drainage fluid. Thus, wound fluid may be involved in suppressing parathyroid hormone secretion.

The use of thyroid flap for preserving laryngeal function in laryngeal cancer.

Preserving laryngeal function after partial laryngectomy for laryngeal cancer is an important consideration. Therefore, we examined the use of thyroid flaps for this purpose. We analyzed 21 patients who underwent thyroid flap reconstruction after partial laryngectomy for laryngeal cancer in the Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital of Central South University from January 2010 to January 2020. All patients were male and aged 51-64 years. Seventeen patients underwent modified tracheocricohyoidoepiglottopexy, and the remaining four patients underwent modified cricohyoidopexy. The thyroid flap was pedicled from the superior thyroid blood vessels. In the modified tracheocricohyoidoepiglottopexy, the flap was turned to cover the area between the tracheal ring and epiglottis to reconstruct the anterior wall of the cricoid cartilage, whereas in the modified cricohyoidopexy, it was turned over between the cricoid cartilage and tongue root to reduce anastomotic tension. A total of seven patients underwent radiotherapy and chemotherapy after surgery. Thyroid flap reconstruction was successfully performed in all patients. The postoperative hospitalization time was 9-21 days, the postoperative nasal feeding time was 18-47 days, and the tracheotomy tube was removed 30-160 days after surgery. No laryngeal stenosis, flap necrosis, bleeding complication, or dysfunction of the thyroid and parathyroid glands was observed after surgery. Two patients experienced wound infections about 1 week after discharge and were admitted again for antibiotic treatment. After dressing and compressing the neck wound, the patients were discharged. Three patients experienced local tumor recurrence after surgery, two of whom did not receive radiotherapy and chemotherapy after modified tracheocricohyoidoepiglottopexy. No patients had distant metastasis after surgery. Thyroid flaps have significant application value in the reconstruction of the laryngeal cavity after partial laryngectomy for laryngeal cancer. It has high safety and feasibility, convenient surgical procedure, and satisfactory postoperative outcomes.

Strategies for reoperative parathyroidectomy

Reoperative parathyroidectomy presents unique challenges and increased risks compared to initial surgeries. A thorough preoperative assessment is crucial, incorporating history, physical exams, laboratory evaluations, imaging studies, operative notes, pathology reports analysis, and postoperative complication reviews. Ectopic parathyroid glands further complicate reoperative procedures, necessitating careful consideration in surgical planning. Radioguided parathyroidectomy offers a safe and successful option for reoperative cases, and is particularly beneficial for detecting ectopic glands.

HISTOMORPHOLGICAL STUDY OF THE PARATHYROID GLAND OF ONE-HUMPED CAMEL (CAMELUS ‎DROMEDARIUM)‎

Parathyroid gland of ten adult one-humped came] has been collected from the slaughter house. Glands have been fixed sectioned and stained by several procedures. The gland measured 1.2 cm in length, 0.4 cm in width and 0.25 cm thick. It differs in position from left to right side due to displacement of thyroid gland. The gland consisted of aggregate of cells arranged as solid masses, clusters, cords or strands. The parenchyma of the gland appeared with different cell density. Four cell type has been distinguished, viz., light as well as dark chief cells, oxyphils and syncytial cells.

Trends in using intraoperative parathyroid hormone monitoring during parathyroidectomy: Protocol and rationale for a cross-sectional survey study of North American surgeons.

Hyperparathyroidism is a common endocrine disorder that occurs secondary to abnormal parathyroid gland functioning. Depending on the type of hyperparathyroidism, surgical extirpation of hyperfunctioning parathyroid glands can be considered for disease cure. Intraoperative parathyroid hormone (IOPTH) monitoring improves outcomes in patients undergoing surgery for primary hyperparathyroidism, but studies are needed to characterize its institutional adoption and its role in surgery for secondary and tertiary hyperparathyroidism, as these entities can be difficult to cure. Hence, we will perform a cross-sectional survey study of surgeon rationale, operational details, and barriers associated with IOPTH monitoring adoption across North America. We will utilize a convenience sampling technique to distribute an online survey to head and neck surgeons and endocrine surgeons across North America. This survey will be distributed via email to three North American professional societies (i.e., Canadian Society for Otolaryngologists-Head and Neck Surgeons, American Head and Neck Society, and American Association of Endocrine Surgeons). The survey will consist of 30 multiple choice questions that are divided into three concepts: (1) participant demographics and training details, (2) details of surgical adjuncts during parathyroidectomy, and (3) barriers to adoption of IOPTH. Descriptive analyses and multiple logistic regression will be used to evaluate the impact of demographic, institutional, and training variables on the use of IOPTH monitoring in surgery for all types of hyperparathyroidism and barriers to IOPTH monitoring adoption. Ethics approval was obtained by the Hamilton Integrated Research Ethics Board (2024-17173-GRA). These findings will characterize surgeon and institutional practices with regards to IOPTH monitoring during parathyroid surgery and will inform future trials aimed to optimize the use of IOPTH monitoring in secondary and tertiary hyperparathyroidism.

Comparing early and delayed [99mTc]Tc-MIBI SPECT/CT parathyroid scans: agreement, confidence levels, and clinical predictive factors

BackgroundParathyroid scan is an important imaging modality for localizing hyperfunctioning parathyroid tissue in patients with hyperparathyroidism. Unfortunately, whether early or delayed timing is the optimal protocol for [99mTc]Tc-MIBI SPECT/CT parathyroid remains under debate. This study aimed to evaluate the agreement and compare the confidence levels of physicians when interpreting early and delayed [99mTc]Tc-MIBI SPECT/CT parathyroid scans. Additionally, it sought to identify clinical factors that related to positive scan result. We conducted a prospective study where the early and delayed [99mTc]Tc-MIBI SPECT/CT was separately interpreted as either positive or negative. Furthermore, these interpretations were categorized based on whether they fell within more or less confidence levels of the readers and were correlated with clinical information.ResultsWe enrolled 39 patients with hyperparathyroidism with 158 possible locations of parathyroid glands. The per-location agreement between the early and delayed scans was moderate (concordant rate: 80.3%, Kappa = 0.558), and the per-patient agreement was slight (concordant rate: 71.8%, Kappa = 0.093). The confidence of interpretation was significantly higher for the delayed scans. Calcium supplementation, low serum parathyroid hormone levels, and low serum phosphate levels were associated with positive early scans. High calcium level and high parathyroid hormone levels were associated with positive delayed scans.ConclusionsOur study highlights the impact of the timing of SPECT/CT in [99mTc]Tc-MIBI parathyroid scans. The different confidence levels between early and delayed scans, along with clinical factors, imply that various factors affect parathyroid scan interpretation, and individualized scanning protocols adjusted for specific settings may be needed to optimize the successful localization of hyperfunctioning parathyroid tissue.

Ultrasonographic features of normal parathyroid glands confirmed during thyroid surgery in adult patients.

This study was performed to examine the ultrasonography (US) features of normal parathyroid glands (PTGs) that were identified on preoperative US and subsequently confirmed during thyroid surgery. This retrospective study included a consecutive sample of 161 patients (mean±standard deviation age, 56±14 years; 128 women) with 294 normal PTGs identified on preoperative US PTG mapping and confirmed during thyroidectomy. A presumed normal PTG on US was defined as a small, round to oval, hyperechoic structure in the central neck. These presumed normal PTGs, as identified on preoperative US, were mapped onto thyroid computed tomography images and diagrams of the thyroid gland and neck. During the preoperative real-time US examinations, the location, size, shape, echogenicity, echotexture, and intraglandular vascular flow of the identified presumed PTGs were assessed. These characteristics were compared between superior and inferior PTGs using the generalized estimating equation method. The typical US features of homogeneous hyperechogenicity without intraglandular vascular flow were observed in 267 (90.8%) normal PTGs, while atypical features, including isoechogenicity (1.0%), heterogeneous echotexture with focal hypoechogenicity (5.8%), and intraglandular vascular flow (3.7%), were noted in 27 (9.2%). Inferior PTGs were more frequently identified in posterolateral (36.1% vs. 5.3%) and thyroid pole locations (29.9% vs. 5.3%), and less frequently in posteromedial locations (29.2% vs. 88.0%), compared to superior PTGs (P&lt;0.001 for each comparison). Most normal PTGs displayed the typical US features of homogeneous hyperechogenicity without intraglandular vascular flow. However, in rare cases, normal PTGs exhibited atypical features, including isoechogenicity, heterogeneous echotexture with focal hypoechogenicity, and intraglandular vascular flow.