ObjectiveTo analysis the clinical symptoms, diagnosis, and treatment of primary hyperparathyroidism (PHPT). MethodsA retrospective study was made in consecutive patients with PHPT who performed operation and had integral data between January 2004 to December 2012 in West China Hospital. ResultsThe 136 cases were composed of 52 cases (38.23%) bone types, 17 cases (12.50%) nephrocalcinosis, 7 cases (5.15%) skeletal and renal involvements, 24 cases (17.65%) asymptomatic primary hyperparathyroidism, and 36 cases (26.47%) combined with other clinical symptoms. The preoperative parathyroid hormone (PTH) levels were (106.20±88.88) pmol/L (6.91-390 pmol/L) and serum calcium were (3.12±0.66) mmol/L (2.15-5.77 mmol/L). The coincidence rate between the examinations preoperation and pathology:B type ultrasound was 75.00%, 99Tcm-MIBI scan was 85.29%, ultrasound and 99Tcm-MIBI combined with computerized tomography (CT) scan was 86.76%. Pathology presentation:129 patients (94.85%) were benign lesions, 7 cases (5.15%) were parathyroid carcinoma. Of the 129 patients, 114 cases (95.80%) were single parathyroid adenoma, 5 cases (4.20%) were multiple parathyroid adenoma or combined parathyroid hyperplasia, 10 cases (7.75%) were parathyroid hyperplasia. Of the patients, the PTH level decreased to below normal upper limit within 3 days after surgery in 124 cases (91.18%). One hundred and twenty-four cases (91.18%) were followed-up. The follow-up time was 6-112 months, a median follow-up time was 49 months. Twelve patients (8.82%) were lost to follow-up, 2 patients (1.47%) with carcinoma recurrence, the rest patients without recurrence and metastasis. Three patients (2.20%) with parathyroid carcinoma died. Of the 3 patients, 2 died of systemic metastasis of parathyroid carcinoma in 18 and 23 months after surgery, 1 died of cardiovascular accident in 19 months after surgery. ConclusionSurgical excision of the lesion parathyroid tissue is the most effective treatment for PHPT.
FromJune1989toMarch1998,11casesofprimaryhyperparathyroidism(PHP)hadbeentreatedsurgicallyin .thishospital.Thepreoperativelocalizationof9caseswereachievedbyoneortwononinvasivetechniquesincludingultrasonography,computedtomography,colorDopplerimagingand99mTcMIBIscintigraphy.Parathyroidectomyweredonesuccessfullyin10of11caseswiththepathologicalresultsofadenomain10casesandonenormalparathyroid.Theauthorsemphasize①earlyrecognitionanddiagnosiswhichcanbehelpedbythenoninvasivetechniquesmentionedaboveforlocalization,②familiaritywiththelocalanatomyespeciallyfortheectopicparathyroidtogetherwithfrozensectionbiopsyduringoperation,and③intensivemedicalcareaftersurgeryandfollowupsoastoheightenthecapacityofdiagnosisandtreatmentofthisdisease.
To standardize the treatment of secondary hyperparathyroidism and effectively meet the needs of practical clinical work, we gathered experts and nursing experts from Departments of Thyroid Surgery, Nephrology, Endocrinology and Metabolism, Nuclear Medicine, Ultrasound, Anesthesiology, Cardiology, and other departments at West China Hospital of Sichuan University to solicit opinions. This consensus was finally established based on published guidelines and the best evidence in Chinese and English combined with clinical practice. This consensus is intended to summarize and conclude, to the greatest extent possible, the practical issues encountered in diagnosing and treating secondary hyperparathyroidism in perioperative settings and to provide recommendations for clinical practice.
ObjectiveTo evaluate the diagnostic value of 99Tcm-methoxy isobutyl isonitrile (MIBI) dual-time imaging for parathyroid adenoma (PA) and parathyroid hyperplasia (PH).MethodsClinical data of 187 patients with pathologically confirmed hyperparathyroidism (HPT) who admitted to the First Affiliated Hospital of Xi’an Jiaotong University School of Medicine from July 2011 to December 2018 were retrospectively collected. Taking postoperative pathology as the standard, the diagnostic value of preoperative 99Tcm-MIBI dual-time imaging was analyzed.ResultsThe serum PTH level of PH patients was higher than that of PA patients (Z=–3.23, P<0.01). Te/N (T: focal area radioactive count, N: the normal tissue radioactivity count of the corresponding thyroid gland on the opposite side of the lesion) in PA and PH patients were lower than Td/N (Z=–3.61, P<0.01; Z=–3.47, P<0.01). The positive rates of 99Tcm-MIBI dual-time imaging in the diagnosis of PA and PH lesions were 67.9% (36/53) and 20.6% (86/418), respectively, and the positive rate of PA were higher (χ2=52.51, P<0.01). The positive rate of 99Tcm-MIBI dual-time imaging in the diagnosis of PA and PH single lesions was higher than that of multiple lesions (χ2=15.79, P<0.01; χ2=64.73, P<0.01). Conclusions99Tcm-MIBI dual-time imaging shows a higher positive rate for PA and a lower positive rate for PH. When HPT is clinically suspected, but 99Tcm-MIBI dual-time imaging is negative and serum PTH is positive, PH should be considered, and B ultrasound and other examinations should be performed to determine the lesion site.
ObjectiveTo assess the clinical efficacy of percutaneous transplantation of parathyroid glands into the subcutaneous tissue of the epigastrium for treating malignant secondary hyperparathyroidism (SHPT). MethodsThe clinical data of the patients with SHPT who were treated by puncturing the subcutaneous tissue of the epigastrium and transplanting parathyroid glands in the Xuzhou Central Hospital from January 2020 to June 2022 were collected retrospectively. The preoperative and postoperative parathyroid hormone (PTH) level, calcium ion concentration, alkaline phosphatase (ALP) level, and phosphorus ion concentration, as well as postoperative follow-up results were analyzed. The data analysis was conducted using SPSS 23.0 software, with a testing level of 0.01. ResultsA total of 21 patients successfully underwent this surgery, including 12 males and 9 females, with a median age of 48 years old and a range of 32–71 years old. The dialysis time was (8.62±2.27) years, and 12 patients had hypertension, 9 patients had anemia, 17 patients had bone pain, and 11 patients had skin itching. On day 1 after treatment, the PTH level decreased from (1 893.23±539.30) ng/L to (5.99±3.50) ng/L (P<0.001), the calcium ion concentration decreased from (2.52±0.31) mmol/L to (2.24±0.35) mmol/L (P=0.003), and the phosphorus ion concentration decreased from (2.25±0.71) mmol/L to (1.76±0.38) mmol/L (P=0.006) as compared with the values before surgery. Although the ALP level decreased from (321.78±151.01) U/L to (229.32±89.32) U/L, there was no statistically significant difference (P=0.016). Among the 12 patients with hypertension before surgery, 6 patients improved and reduced the use of antihypertensive drugs after surgery; among the 9 patients with anemia, 3 patients improved before discharge; 17 patients with bone pain showed markedly relief before discharge; and 9 patients with skin itching improved before discharge. There were no complications such as hoarseness, choking cough when drinking water, or incision infection after the operation. All 21 patients were followed up for 6–12 months. The parathyroid hormone levels of the 21 patients all dropped to the normal level within 12 months after the operation. Among them, 3 patients recovered to the normal level at the 3rd month after the operation, 16 patients recovered to the normal level at the 6th month after the operation, and 2 patients recovered to the normal level at the 12th month after the operation. The time to return to the normal level was (5.86±2.70) months. No serious complications occurred in all patients, and there was no recurrent case during follow-up period. Conclusion From the analysis results of our study, parathyroid autotransplantation into the subcutaneous tissue of the epigastrium via puncture is a safe and effective method for patients with SHPT.
Objective To summarize the research progress of the treatment of primary hyperparathyroidism (PHPT) in multiple endocrine neoplasm type 1 (MEN1). Method The literature about the treatment of PHPT in MEN1 in recent years was reviewed. Results When the symptoms of MEN1 related PHPT were obvious, surgery was an effective treatment. In addition to conventional total parathyroidectomy with autotransplantation and subtotal parathyroidectomy, less-than subtotal parathyroidectomy, and single gland excision had also been proved to be effective recently. Conclusions Combining the clinical manifestations with the actual involvement of the parathyroid of MEN1 related PHPT patients, personalized selection of appropriate timing and methods of parathyroidectomy can help MEN1 related PHPT patients obtain ideal parathyroid function and ensure the quality of life to the greatest extent.
ObjectiveTo summarize the current treatment status of uremic secondary hyperparathyroidism (SHPT) in order to improve the understanding of uremic SHPT and to guide clinical work.MethodThe relevant literatures at home and abroad on surgical treatment of uremic SHPT were readed and reviewed.ResultsFor intractable SHPT patients with ineffective medical treatment, surgical treatment was still irreplaceable, which could significantly improve biochemical indicators and quality of life of SHPT patients. However, there was no unified standard for surgical indications and the choice of different operation methods. In addition, there was a certain controversy about whether there was a need for preoperative parathyroidectomy in patients with SHPT who were willing to have a kidney transplant.ConclusionAlthough there are still some problems need to be solved in surgical treatment of SHPT, however, it’s widely recognized and used by clinicians, which can improve the symptoms of SHPT patients and bring bettersurvival benefits.
ObjectiveTo compare the efficacy of subtotal parathyroidectomy(sPTX) and total parathyroidectomy (tPTX) plus parathyroid autotransplantation(AT) in treatment of secondary hyperparathyroidism(SHPT). MethodsClinical data of 76 cases of uremia SHPT who underwent sPTX(n=19) and tPTX+AT(n=57) in Xinjiang Armed Police Corps Command Military Hospital and The Xinjiang Uygur Autonomous Region People's Hospital were retrospectively analyzed(from Feb. 2005 to Sep. 2012). ResultsOf the 76 cases, 68 cases(89.5%) got successful surgery and 8 cases (10.5%) suffered non-complete resection, all cases had relief on bone pain, and 14 cases had relief on pruritus(26.9%, 14/52). The values of serum calcium on 1 day, 7 days, and 6 months after operation were lower in tPTX+AT group (P<0.05), and value of iPTH in 6 months after operation was lower too(P<0.05). The operation time, blood loss, hospital stay, and hospital cost in tPTX+AT group were all higher or longer(P<0.05). All of the 76 cases were followed up for 6-18 months(the median time was 8.7 months). During the followed-up, 2 cases died and 2 cases recurred in tPTX+AT group, 1 case died and 7 cases recurred in sPTX group, that the recurrence rate was higher in sPTX group (P<0.05). ConclusiontPTX+AT has lower recurrence rate, but with longer operation time and hospital stay, more blood loss, and expensive cost, so the choice of surgery for SHPT should be based on the comprehensive situation.
Vague preoperative localization and ectopic parathyroid often lead to the failure of operation in primary hyperparathyroidism. From Jun 1989 to March 1998, 11 cases of primary hyperparathyroidism had been treated surgically in the general surgery department of our hospital. Of them, 10 cases were operated successfully with the pathological diagnosis of adenoma and one parathyroid removed was reported normal. Preoperative localization, the knowledge of ectopic parathyroids, careful exploration during operation and the postoperative medical treatment are important for the perioperative management. Postoperative followup has emphasized to benefit the treatment in primary hyperparathyroidism.
ObjectiveTo explore the selection and application value of preoperative stereotactic localization in the surgical treatment of secondary hyperparathyroidism.MethodsThe preoperative ultrasound, CT, and methoxyisobutylisonitrile (MIBI) scan data of 54 patients with secondary hyperparathyroidism confirmed by pathological examination in the Department of General Surgery of the 900th Hospital of the Joint Logistics Team from September 2016 to January 2020 were retrospectively analyzed, to explore the localization accuracy of the three methods alone or in combination.ResultsIn this study, a total of 207 parathyroids were detected, 1 was misdiagnosed (ectopic thymus),9 were missed, and 216 parathyroids were removed. The preoperative localization accuracy of CT, ultrasound, and MIBI was the highest (95.39%, 207/217), followed by ultrasound and MIBI (93.55%, 203/217) and CT+MIBI (89.40%, 194/217), compared with other single or two methods, the differences were statistically significant (P<0.05). The accuracy of CT combined with ultrasound localization (82.49%, 179/217) was slightly higher than that of MIBI scan alone (78.80%, 171/217), but the difference was not statistically significant (P=0.060). Although the location accuracy of MIBI scan was slightly higher than that of ultrasound localization (77.88%, 169/217), the difference was not statistically significant (P=0.084).ConclusionIn order to maximize the accuracy of preoperative stereotactic localization of secondary hyperparathyroidism, ultrasound, CT, and MIBI should be combined.