甲状旁腺全切术对继发性甲状旁腺功能亢进的治疗效果

目的观察甲状旁腺全切除术对继发性甲状旁腺功能亢进的治疗效果。方法选择因尿毒症引起的继发性甲状旁腺功能亢进就诊于娄底市中心医院耳鼻咽喉头颈外科且长期行血液透析治疗患者14例。对患者手术前后血液中全段甲状旁腺激素(parathyroid hormone, PTH)、血清钙值、临床症状、术后并发症、死亡率和复发情况进行回顾性分析,结合相关文献进行总结讨论。结果14例患者术后无一例死亡,未见明显声嘶及术后切口出血,所有患者均伴有低钙血症,术后四肢麻木,血清钙术后1周内下降明显,给予对症支持治疗,1周后逐渐回升至正常水平。术后复查PTH明显降低。患者术后骨痛及皮肤瘙痒症状全部得到缓解,肌无力、纳差症状得到明显改善,全身营养状况好转。结论甲状旁腺全切除术治疗终末期肾病所致的继发性甲旁腺功能亢进是一种安全、有效的方法。     

继发性甲状旁腺功能亢进不同手术方式的疗效分析

目的　分析比较甲状旁腺次全切除术和甲状旁腺全切+前臂自体移植术对于治疗尿毒症继发性甲状旁腺功能亢进的临床疗效。方法　回顾性分析2012年1月~2018年6月在大连市友谊医院行手术治疗的继发性甲状旁腺功能亢进患者资料31例。病例分为2组,Ⅰ组行甲状旁腺次全切除术（20例）,Ⅱ组行甲状旁腺全切+前臂自体移植术（11例）。对患者术前,术后1周、1、3、6个月血钙、血磷、血PTH水平、临床症状改善程度等资料进行分析。结果　术后血钙、血磷、血iPTH均较术前明显下降,差异有统计学意义（P <0.05）。两组间术前、术后血钙、血磷及术后6个月血iPTH的水平差异不大,无统计学意义（P >0.05）。两组患者术后骨痛、皮肤瘙痒、不安腿综合征均得到明显改善,两组间症状减轻程度差异无统计学意义（P >0.05）。结论　两种术式均能有效治疗尿毒症继发性甲状旁腺功能亢进,手术安全性高,两组对血钙、血磷的影响无明显差异,全切+前臂自体移植组短期内甲状旁腺激素下降更加明显。二者均存在复发的可能性,全切+前臂自体移植术二次手术简便易行,具有一定的优势。     

甲状旁腺全切术治疗难治性继发性甲状旁腺功能亢进症

目的　研究甲状旁腺全切术（t o t a l l y parathyroidectomy，TPTX）治疗难治性继发性甲状旁腺功能亢进症（secondary hyperparathyroidism，SHPT）的临床疗效。方法　对21例药物治疗抵抗的难治性SHPT患者行TPTX，观察术前术后血清全段甲状旁腺激素（intact parathyroid hormone，iPTH）、血钙、血磷、碱性磷酸酶变化情况，并观察术后患者临床症状改善、静脉补钙时间及术后并发症情况。结果　21例患者共切除甲状旁腺83枚，全部患者骨痛、皮肤瘙痒等临床症状明显缓解或消失， 术后iPTH、血钙、血磷明显下降，与术前比较有统计学意义（P <0.05），术前术后碱性磷酸酶变化无统计学意义（P >0.05），全部患者均于术后0~8天内停止静脉补钙，术后静脉补钙时间（3.43±2.31）天，术后静脉补钙时间与术前iPTH水平有相关性（P <0.05），与术前碱性磷酸酶水平无相关性（P >0.05），术后随访1个月~3年，无顽固性低钙血症出现，无严重术后并发症出现，无术后复发。结论　TPTX疗效确切，术后复发率低，无严重术后并发症，是治疗难治性SHPT的安全有效手术方式。     

甲状旁腺切除术治疗继发性甲状旁腺功能亢进

目的了解甲状旁腺切除术对继发性甲状旁腺功能亢进的治疗作用。方法回顾性总结11例继发性甲状旁腺功能亢进的慢性肾功能衰竭尿毒症期患者行甲状旁腺切除术的病例,比较术前、术后血甲状旁腺素(parat hyroidhormone,PTH)值和血钙值及临床表现的变化。结果术后11例患者中9例血PTH值恢复正常,2例正常偏高但较原来降低十倍;血钙值均恢复正常;骨痛、骨质疏松症状明显改善。结论甲状旁腺切除术对继发性甲状旁腺功能亢进的患者具有较好的治疗作用。     

肾性继发性甲状旁腺功能亢进外科手术疗效分析

目的 探讨并比较甲状旁腺次全切除术和甲状旁腺全切加前臂移植术治疗肾性继发性甲状旁腺功能亢进的临床疗效。方法 回顾性分析15例患者资料,其中 11例行甲状旁腺次全切除术（Ⅰ组）,4例行甲状旁腺全切加前臂移植术（Ⅱ组）,比较术前、术后第1天和6个月患者血PTH、血钙水平及临床症状改善情况。结果 Ⅰ、Ⅱ组患者术后第1天及6个月血PTH较术前均有显著下降,配对t检验差异有统计学意义（Ⅰ组：P值分别为0.0007、0.0002,P＜0.05;Ⅱ组：P值分别为0.0116、0.0196,P＜0.05）,两组PTH手术前后差值进行两独立样本t检验,差异无统计学意义（第1天：P＝0.2670＞0.05;6个月：P＝0.4920＞0.05）。结论 对内科治疗无效的肾性继发性甲状旁腺功能亢进患者,甲状旁腺次全切除术及甲状旁腺全切＋前臂移植术都是有效的治疗方法,且两种手术方式在术后短期内（术后1天及6个月）的治疗效果无统计学差异。     

术中甲状旁腺激素测定在甲状旁腺切除中应用

人体甲状旁腺合成和分泌甲状旁腺激素,甲状旁腺激素作用于骨骼和肾脏,从而调节血钙水平。甲状旁腺自身病变或其他疾病引起钙磷紊乱,导致甲状旁腺过度分泌甲状旁腺激素引起甲状旁腺功能亢进。继发性甲状旁腺功能亢进是慢性肾脏病患者的常见并发症之一,引起钙磷代谢失调、骨组织病变等一系列临床症状。对于难治性继发性甲状旁腺亢进,甲状旁腺切除术是主要的治疗手段。术中甲状旁腺激素测定是甲状旁腺手术过程中的一种功能性诊断工具,可以预测手术成功与否,并帮助术者决定是否需要进一步的探查,从而减少不必要的探查所导致的手术并发症。     

继发性甲旁亢甲状旁腺全切术后嗓音变化研究

目的 观察继发性甲状旁腺功能亢进甲状旁腺全切术后患者嗓音的变化.方法 选择继发性甲状旁腺功能亢进患者29例,其中男18例,平均(43±12)岁;女11例,平均(50±12)岁.患者术前及术后第5天测试F0、Jitter、Shimmer和噪比等嗓音分析指标,以及最大发音声时(MPT)和血钙浓度.测试术前术后第1天的血清甲...     

亚甲蓝在继发性甲旁亢手术中对甲状旁腺的定位作用

目的 探讨亚甲蓝正显影染色法在甲状旁腺全切术中对甲状旁腺的定位作用。 方法 将49 例行甲状旁腺全切术的继发性甲状旁腺功能亢进(SHPT)患者分为两组,术中静滴亚甲蓝染色定位甲状旁腺25例作为试验组,无任何显影方法辅助24例作为对照组。比较两组手术时间、手术成功率、不良反应发生率、甲状旁腺的检出率及阳性预测值。 结果 两组比较手术时间、手术成功率差异均有统计学意义(P<0.01,P=0.05);术后发生亚甲蓝相关不良反应分别为1例、0例,差异无统计学意义(P=1.00);检出率分别为99.00%、92.86%,差异有统计学意义(P=0.03);阳性预测值分别为97.06%、91.92%,差异无统计学意义(P=0.11)。 结论 在继发性甲状旁腺功能亢进症患者行甲状旁腺全切术中,亚甲蓝正显影染色法是快速、安全而有效的定位方法。     

继发性甲状旁腺功能亢进甲状旁腺全切除术的探讨北大核心CSCD

目的探讨维持性透析肾病患者继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)行清扫式甲状旁腺全切除术(dissection parathyroidectomy,dPTX)的临床价值。方法回顾性分析北京民航总医院耳鼻咽喉头颈外科2009年9月至2017年9月收治的195例维持性透析肾病患者SHPT的临床资料,其中男性92例,女性103例,年龄23~77岁。首次手术167例,外院术后持续性或复发性SHPT再次手术28例。采用dPTX切除全部甲状旁腺,同期行胸锁乳突肌移植。比较手术前后症状缓解程度,血清全段甲状旁腺素、血钙、血磷、血红蛋白和红细胞压积的变化。采用SPSS 22.0统计学软件进行统计学分析。结果经术后病理证实,195例患者共切除增生的甲状旁腺804枚。其中术中肉眼识别且位置明确的甲状旁腺765枚,位于双侧气管食管沟内577枚(75.4%),异位甲状旁腺188枚(24.6%)。术中肉眼未识别出、位置不明确而在清扫组织标本中病理检出的甲状旁腺39枚(4.9%),来自22例患者(11.3%)。额外甲状旁腺患者的发生率为14.4%(28/195)。围手术期未发生严重的并发症。术后半年所有患者骨痛、皮肤瘙痒症状全部缓解,肌无力、不宁腿、贫血及睡眠质量均明显改善。术后半年血清全段甲状旁腺素(70.31±60.12)pg/ml、血钙(2.13±0.22)mmol/L、血磷(1.17±0.27)mmol/L均较术前[分别为(1501.02±167.26)pg/ml、(2.40±0.32)mmol/L、(2.27±0.50)mmol/L]下降,差异有统计学意义(t值分别为4.982、2.325、7.326,P值均<0.01)。术后半年血红蛋白(120.32±10.63)g/L和红细胞压积(39.20±3.21)%较术前[分别为(104.11±15.17)g/L、(31.25±5.12)%]升高,差异有统计学意义(t值分别为12.22、18.37,P值均<0.05)。结论dPTX治疗维持性透析肾病患者的SHPT安全可靠。     

术中甲状旁腺激素测定评判继发性甲状旁腺功能亢进手术成功的标准构想

目的 探讨继发性甲状旁腺功能亢进(SHPT)在甲状旁腺近全切术和甲状旁腺全切术应用术中甲状旁腺激素(IOPTH)测定方法预测手术成功标准。 方法 105例SHPT患者行甲状旁腺近全切或全切除术,分别于麻醉后切开皮肤前测PTH值(PTH₀)及最后一个甲状旁腺近全切或全切除后10 min测PTH值(PTH₁₀)。预测手术成功标准:(1) PTH₁₀值下降至≤150 pg/mL;(2) PTH₁₀/PTH₀≤30%。 结果 96例达标符合手术成功标准,PTH下降在达标与未达标者间差异有统计学意义,且血钙下降明显。设定术后PTH正常和低下为治愈标准,则假阳性率为9.38%,复发率为23.33%。如按K/DOQI指南设定PTH<300 pg/mL为治愈标准,则复发率为5%。随访6个月后,真阳性的血钙、磷下降与术前比较差异有统计学意义,而未达标者差异无统计学意义。 结论 在SHPT行甲状旁腺近全切或全切除术,PTH₁₀/PTH₀≤30%可预测手术成功和治愈。     

Incidental parathyroidectomy during thyroid surgery does not cause transient symptomatic hypocalcemia

OBJECTIVES: To identify any risk factors for incidental parathyroidectomy and to define its association with symptomatic postoperative hypocalcemia. DESIGN: Retrospective study. SETTING: Tertiary referral cancer center. PATIENTS: Consecutive patients who underwent thyroid surgery between 1991 and 1999. Patients who underwent procedures for locally advanced thyroid cancer requiring laryngectomy, tracheal resection, or esophagectomy were excluded. INTERVENTIONS: All pathology reports were reviewed for the presence of any parathyroid tissue in the resected specimen. Slides were reviewed, and information regarding patient demographics, diagnosis, operative details, and postoperative complications was collected. MAIN OUTCOME MEASURE: Identification of parathyroid tissue in resected specimens and postoperative symptomatic hypocalcemia. RESULTS: A total of 141 thyroid procedures were performed: 69 total thyroidectomies (49%) and 72 total thyroid lobectomies (51%). The findings were benign in 68 cases (48%) and malignant in 73 cases (52%). In the entire series, incidental parathyroidectomy was found in 21 cases (15%). Parathyroid tissue was found in intrathyroidal (50%), extracapsular (31%), and central node compartment (19%) sites. The performance of a concomitant modified radical neck dissection was associated with an increased risk of unplanned parathyroidectomy (P =.05). There was no association of incidental parathyroidectomy with postoperative hypocalcemia (P =.99). Multivariate analysis identified total thyroidectomy as a risk factor for postoperative hypocalcemia (P =.008). In the entire study group, transient symptomatic hypocalcemia occurred in 9 patients (6%), and permanent hypocalcemia occurred in 1 patient who underwent a total thyroidectomy and concomitant neck dissection. CONCLUSIONS: Unintended parathyroidectomy, although not uncommon, is not associated with symptomatic postoperative hypocalcemia. Modified radical neck dissection may increase the risk of incidental parathyroidectomy. Most of the glands removed were intrathyroidal, so changes in surgical technique are unlikely to markedly reduce this risk.     

Clinical course of incidental parathyroidectomy: Single center experience

Objective

Thyroidectomy is a very common surgical procedure. Regardless of surgeon experience, incidental parathyroidectomy is a complication of thyroidectomy. The aim of this study was to identify the clinical course of incidental parathyroidectomies after thyroidectomy.

Careful examination of thyroid specimen intraoperatively to reduce incidence of inadvertent parathyroidectomy during thyroid surgery

OBJECTIVE: To assess the incidence and clinical relevance of inadvertent parathyroidectomy during thyroidectomy, and the possibility of reducing its occurrence. DESIGN: Retrospective study. SETTING: University hospital. PATIENTS: Consecutive patients who underwent thyroidectomy from 1999 to 2005, divided into 2 groups (group 1, those with inadvertent parathyroidectomy; and group 2, those without inadvertent parathyroidectomy). Patients who underwent surgical procedures for recurrent thyroid disease, intentional parathyroidectomy, and resection of central compartment viscera were excluded. INTERVENTIONS: All pathology reports were reviewed for the presence of any parathyroid tissue in the resected specimen. Age, sex, preoperative diagnosis, thyroid hormonal status, substernal thyroid extension, number of parathyroid glands identified and spared at the time of surgery, autotransplantation of parathyroid gland, and final histologic findings were recorded. MAIN OUTCOME MEASURES: Identification of parathyroid tissue in resected specimens and postoperative symptomatic hypocalcemia. RESULTS: A total of 307 patients were included. Surgical procedures included bilateral or unilateral thyroidectomy (95% and 5% of procedures, respectively). Central neck lymph node dissection was performed in 5% of cases. Pathologic findings showed inadvertent parathyroidectomy in 12% of cases. Of these, 32% were recognized intraoperatively. The parathyroid tissue was found in extracapsular locations in 37% of cases, intracapsular locations in 39%, and intrathyroidal locations in 24%. There was no statistical difference between the 2 groups in terms of sex, preoperative diagnosis, substernal extension, extent of surgery, pathologic diagnosis, and occurrence of postoperative hypocalcemia, except for the presence of thyroiditis. CONCLUSION: Careful examination of the surgical specimen intraoperatively decreases the incidence of inadvertent parathyroidectomy during thyroidectomy.     

Intra‐operative parathyroid hormone monitoring in secondary hyperparathyroidism: is it useful?

Objectives: To assess the use of intra‐operative parathyroid hormone (PTH) level monitoring as a predictor of persistent hypoparathyroidism after total parathyroidectomy in renal hyperparathyroidism. Setting: University Teaching Hospital Otorhinolaryngology and Head and Neck Surgery Unit. Participants: All patients with renal hyperparathyroidism undergoing parathyroidectomy between January 2004 and July 2005. Twenty‐nine patients were identified. Main outcome measures: Comparison is made between pre‐ and intra‐operative PTH levels (ioPTH) in patients who at 3 months postoperatively maintained hypoparathyroidism and patients who did not. Results were analysed to see whether ioPTH predicts maintenance of the hypoparathyroid state. Results: The mean preoperative PTH level was 932 pg/L (range: 58–1808). The mean postoperative PTH level was 147 pg/L (range: 16–498). The mean 3‐month PTH level was 47 pg/L (range: <1–515). The mean postoperative PTH level for patients with a persistently high PTH level at 3 months was 286 pg/L (range: 272–299), compared with 63 pg/mL (16–160) in patients remaining normparathyroid, and 159 pg/L (range: 39–498) for patients with persistent hypoparathyroidism. If the normoparathyroid state is strictly considered to be failure following total parathyroidectomy, ioPTH is not predictive of hypoparathyroidism. However, ioPTH is indicative of biochemical resolution of the hyperparathyroid state (normo‐ or hypoparathyroidism). Conclusion: We conclude that the use of ioPTH monitoring in the surgical management of secondary hyperparathyroidism fails to predict persistent hypoparathyroidism following total parathyroidectomy, but does predict biochemical resolution of hyperparathyroidism.     

Persistent parathyroid hormone elevation following curative parathyroidectomy for primary hyperparathyroidism

BACKGROUND: Persistent elevation of parathyroid hormone (PTH) levels following parathyroidectomy may indicate residual abnormal parathyroid tissue. OBJECTIVE: To determine the clinical significance and risk factors for persistent PTH elevation following curative parathyroidectomy. METHODS: A prospective study of consecutive patients with primary hyperparathyroidism who had resolution of hypercalcemia following parathyroidectomy. Patients with low or normal serum calcium and increased PTH levels postoperatively were identified, and serial calcium and PTH levels and clinical course were monitored. A multivariate analysis was performed to identify features associated with an elevated postoperative PTH level. RESULTS: Of 85 patients with resolution of hypercalcemia following parathyroidectomy, postoperative PTH levels were elevated in 23 (27%) (mean, 99 pg/mL; range, 70-194 pg/mL) and normal in 62 (mean, 30 pg/mL; range, 3-65 pg/mL) (P<.001). No significant differences in preoperative or postoperative calcium or preoperative PTH levels were found between groups. Among patients with persistent PTH elevation, 18 had adenoma and 5 had multiglandular disease, compared with 52 with adenoma and 10 with multiglandular disease in patients with normal postoperative PTH levels (P>.05). Multivariate analysis demonstrated that black race and musculoskeletal symptoms were associated with an elevated postoperative PTH level (P =.01. After an average 16-month follow-up, PTH levels normalized in 13 patients, decreased in 5, and were unchanged in 2. Three patients were lost to follow-up. CONCLUSIONS: Persistent PTH elevation occurs in 27% of patients following curative parathyroidectomy and is usually a transient phenomenon more common in patients with musculoskeletal symptoms and of the black race. It is not a manifestation of persistent disease but is most likely a secondary response to bone remineralization.     

Network meta-analysis of surgical treatment for secondary hyperparathyroidism

BackgroundMain surgical treatments for secondary hyperparathyroidism (SHPT) include subtotal parathyroidectomy (sPTX), total parathyroidectomy with autotransplantation (tPTX+AT), and total parathyroidectomy (tPTX); however, determining the best treatment is debatable. We conducted a network meta-analysis (NMA) comparing three treatments in terms of postoperative hypocalcemia (or hypoparathyroidism), postoperative recurrence, and reoperation.MethodsWe searched PubMed, Medline, the Cochrane Library, and Embase for relevant research from inception to July 30, 2019. We performed our Bayesian NMA using R 3.51 software to assess odds ratios (OR) and 95% confidence intervals (CI). Network and forest plots displayed study outputs. Potential publication bias was assessed with funnel plots using software Stata/MP 13.0.ResultsTwenty-six articles comprising 5063 patients were included in our NMA, which showed that postoperative hypocalcemia (or hypoparathyroidism) occurred more frequently in tPTX than in sPTX (OR = 3.50, 95% CI 1.10–11.0) or tPTX+AT patients (OR = 1.80, 95% CI 0.66–5.20). Regarding postoperative hypocalcemia (or hypoparathyroidism), there was no significant difference between sPTX and tPTX+AT (OR = 0.53, 95% CI 0.24–1.10). As for recurrence rates, statistically significant differences were observed between sPTX and tPTX (OR = 25.0, 95% CI 5.1–260), tPTX+AT and tPTX (OR = 20.0, 95% CI 4.2–200), and sPTX and tPTX+AT (OR = 1.30, 95% CI 0.65–2.50). Regarding reoperation rates, sPTX experienced higher incidence compared with tPTX+AT (OR = 1.20, 95% CI 0.53–2.70) or tPTX patients (OR = 2.70, 95% CI 1.20–14.00).ConclusionsTPTX+AT is recommended as the most efficient and safe surgical SHPT treatment with minimal adverse effects. Large-scale randomized controlled trials are recommended to confirm the NMA results.     

Impact of incidental parathyroidectomy and mediastinal-recurrent cellular and lymph-node dissection on parathyroid function after total thyroidectomy

ObjectivesTo determine the impact of incidental parathyroidectomy and mediastinal-recurrent cellular and lymph-node dissection on parathyroid function after total thyroidectomy.Material and methodsA single-center retrospective study was conducted for a 5-year period in a university hospital center, including 605 patients undergoing total thyroidectomy, 52 of whom had mediastinal-recurrent cellular and lymph-node dissection.EndpointsThe main endpoint was intraoperative number of parathyroid glands as predictor of parathyroid hormone (PTH) level and postoperative hypocalcemia. The secondary endpoint was the correlation between associated mediastinal-recurrent cellular and lymph-node dissection and incidental parathyroidectomy and its impact on PTH level and calcemia in the immediate postoperative period and at 1 month.Results161 patients (26.61%) showed hypocalcemia in the immediate postoperative period and 12 (1.98%) at 1 month. Mediastinal-recurrent cellular and lymph-node dissection increased incidental parathyroidectomy risk 4.6-fold. Mediastinal-recurrent cellular and lymph-node dissection was associated with a statistically “suggestive” decrease in day-1 calcemia (P = 0.03), and no significant decrease at 1 month (P = 0.52). Incidental parathyroidectomy (6.7% of cases with parathyroidectomy versus 1.3% without) did not significantly increase the rate of early hypocalcemia (P = 0.28), but was associated with a “suggestive” worsening at 1 month (P = 0.02).ConclusionHypocalcemia after total thyroidectomy is a complex, probably multifactorial issue. Systematic parathyroid gland identification is not recommended due to the increased risk of gland lesion, mainly by devascularization. Incidental parathyroidectomy may induce hypocalcemia at 1 month postoperatively (statistically “suggestive” association).     

Ultrasonography: highly accuracy technique for preoperative localization of parathyroid adenoma

Objectives/Hypothesis: This study evaluates the accuracy of ultrasonography in guided unilateral parathyroidectomy to treat primary hyperparathyroidism. Study Design: Retrospective study. Methods: Two hundred fifty-three patients with primary hyperparathyroidism underwent preoperative ultrasonography. Two groups were defined. Group 1 included the patients in whom the preoperative cervical ultrasound localized one abnormal parathyroid gland; these patients underwent unilateral surgical exploration of the neck under local anesthesia. Group 2 included the patients who had a bilateral neck exploration under general anesthesia when the preoperative examination was equivocal or failed to localize the lesion, when concomitant thyroid pathology indicated thyroidectomy, and when justified by the surgical findings. Results: Sensitivity and positive predictive value of ultrasonography in detecting abnormal parathyroid gland were 96% and 98%, respectively. Cervical ultrasound correctly identified, 96% and 85% of abnormal glands in groups 1 and 2, respectively. The presence of thyroid nodular disease did not affect ultrasonographic accuracy. Sonographic examination decreased the operative time of parathyroidectomy to an average of 15 minutes. Mediastinal and retroesophageal localizations of abnormal parathyroid gland adversely affected the accuracy of the ultrasound. No cervical hematoma was noted. Transient recurrent laryngeal nerve palsy occurred in four patients. Twenty-three patients required postoperative calcium supplementation for 2 to 4 months, and all were normocalcemic at follow-up. Conclusions: Cervical ultrasound is a reliable preoperative exploration allowing parathyroidectomy via unilateral approach under local anesthesia.     

Parathyroid surgery in primary hyperparathyroidism: an update

The best approach to parathyroid removal in primary hyperparathyroidism (HPT) is still a major topic in neck surgery. The present report reviews our experiences with 71 patients operated by parathyroidectomy (PTX) between 1978 and 1987. Preoperative computed tomography, sonographic and double-tracer subtraction scanning examination allowed a precise assessment of the number and the topography of the diseased glands. Consequently, 65 patients underwent partial "selective" PTX, with removal of one or two glands, while 6 patients underwent subtotal PTX. The surgical results can be summarized as follows: full success in 67 cases (94.4%); persistent hypercalcemic syndrome in 3 cases (4.2%); recurrence of HPT in 1 case (1.4%). One case of persistent hypercalcemia was solved by reoperation. Thus, the total success rate was definitively assessed at 95.8%. As a complication of surgery a long-lasting postoperative hypocalcemic syndrome was observed in only 2 patients following subtotal parathyroidectomy. Our overall findings show that an attentive preoperative study by means of modern imaging techniques usually allows a "selective" partial PTX with good results and a low risk of complications.     

Hypocalcemia after parathyroidectomy in patients taking proton pump inhibitors

PurposeLong-term use of proton pump inhibitors is associated with metabolic derangements, including hypocalcemia. Hypocalcemia is also a known complication of parathyroidectomy. We sought to determine the rate of hypocalcemia following parathyroidectomy in patients on proton pump inhibitors.Materials and methodsThe TriNetX Research Network was queried to identify patients with a history of primary hyperparathyroidism treated with parathyroidectomy between 2012 and 2022. The incidence of short-term (0–6 months following parathyroidectomy) and permanent (6–12 months following parathyroidectomy) postoperative hypocalcemia was compared between patients using proton pump inhibitors and those who were not.ResultsOf 34,595 total patients, 19.5 % (n = 6753) were taking proton pump inhibitors prior to surgery. Patients taking proton pump inhibitors were significantly more likely to experience both short-term (RR, 95 % CI, P) (1.5, 1.4–1.6, P < 0.001) and permanent (1.8, 1.6–2.1, P < 0.001) hypocalcemia, and were also more likely to be evaluated in the emergency department after surgery (1.5, 1.4–1.7, P < 0.001).ConclusionsOur study is the first to indicate an increased risk of hypocalcemia after parathyroidectomy in patients on proton pump inhibitors.