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PubMed1985

Blood pressure in patients with primary hyperparathyroidism before and after parathyroidectomy.

Studies were performed in 86 patients with proven primary hyperparathyroidism pre-operatively and 6-7 months after parathyroidectomy. The 29% incidence of hypertension between patients with primary hyperparathyroidism is higher as compared with the incidence of hypertension in the general population. Systolic and diastolic blood pressures were significantly higher in patients with primary hyperparathyroidism before operation than after parathyroidectomy (p less than 0.001). In patients hypertensive before operation both the systolic and diastolic blood pressure significantly fell after parathyroidectomy (p less than 0.001). The blood pressure was found to have normalized in 13 of the 25 patients with hypertension. Renal damage and changes in renin levels are not the mechanisms in the production of hypertension in hyperparathyroid patients.

Adolescent↗
PubMed1977

Chondrocalcinosis in primary hyperparathyroidism. Influence of age, metabolic bone disease, and parathyroidectomy.

Chondrocalcinosis is known to be common in hyperparathyroidism. In order to discover the effect of parathyroidectomy on chondrocalcinosis and to investigate this association further, we studied two groups of patients. In one group were 41 postparathyroidectomy patients, and in the other 100 admissions to the acute geriatric unit. The total incidence of chondrocalcinosis in the parathyroidectomy group was 32%, and in the elderly control group 11%. There was little or no osteoarthrosis in these patients. It was found that chondrocalcinosis occurred in the normal population from the age of 75 and in the hyperparathyroid group from the age of 45. In both groups the incidence rose steadily with age. In the hyperparathyroid group alone, preoperative serum calcium levels were no different in those without chondrocalcinosis, suggesting that hypercalcaemia alone is not a sufficient stimulus for chondrocalcinosis. Those with chondrocalcinosis had higher mean preoperative alkaline phosphatase levels, nearly twice as much radiological bone disease, and were older. Parathyroidectomy had no effect on attacks of pseudogout or on preexisting cartilage calcification. A connection with high levels of circulating parathyroid hormone is suggested, and a link with physical age-related changes in cartilage postulated.

Adult↗
PubMed1982

Parathyroidectomy significantly decreases hypertension in spontaneously hypertensive and deoxycorticosterone plus saline treated rats.

In male Sprague--Dawley rats, hypertensive development was diminished for 10 weeks when parathyroidectomy (PTX) was performed 1 week before deoxycorticosterone plus saline (DOCA + NaCl) treatment. In young spontaneously hypertensive male rats (SHR, Okamoto strain) parathyroidectomy performed after weaning lessened hypertensive levels and lowered heart rate for 24 weeks. When mineralocorticoid or genetic hypertension was established, parathyroidectomy did not significantly change blood pressure levels. High dietary calcium in PTX--SHR rats reestablished normal serum calcium but not systolic blood pressure to the level of sham SHR. From our present and previously reported results, it appears that the parathyroid gland is necessary for the total development of hypertension in both models.

Aging↗
PubMed1976

Metabolic effects of parathyroidectomy in asymptomatic primary hyperparathyroidism.

Effects of parathyroidectomy on parathyroid function and calcium (Ca) metabolism were carefully evaluated in 6 patients with primary hyperparathyroidism without symptoms normally attributed to the disease and in 7 with bone disease or nephrolithiasis. Before parathyroidectomy, both groups of patients demonstrated evidence of the sequelae of parathyroid hormone (PTH) excess, since they presented one or more of the following features: low bone density by 125I-photon absorption, hypercalciuria (urinary Ca greater than 200 mg/day on an intake of 400 mg/day), negative Ca balance (absorbed Ca less than urinary Ca), elevated fasting urinary Ca greater than 0.2 mg/mg creatinine for a night-time sample after a 6-hour fast), and decreased renal function (creatinine clearance of less than 65 ml/min). Following parathyroidectomy, most of these deleterious effects were reversed commensurate with the return of immunoreactive serum PTH, serum Ca, and urinary cyclic AMP toward normal. These quantitative non-invasive techniques may be useful for the initial evaluation and follow-up of patients with asymptomatic primary hyperparathyroidism.

Adult↗
PubMed1986

[An increase in calcitonin levels in the thyroid gland of infant rats following parathyroidectomy].

It is well known that serum calcitonin (CT) levels in infantile rats are higher than those in adult rats. In the present experiment, the effects of parathyroidectomy or calcium administration on serum calcitonin levels were observed in suckling rats. Bilateral parathyroidectomy (Px) on 3-, 5-, 7-, 8- or 14-day-old Wistar-Imamichi female rats was performed surgically under a dissecting microscope. Ether anesthesia was used. In the first experiment, the Px rats of various age groups were killed 1 week after the operation. In the second experiment, time course effects of Px on one-week-old rats were observed 1, 2 or 3 weeks after the operation. CT in the serum and thyroid extracts (0.001N HCl) was measured using radioimmunoassay kits for human CT. Serum Ca was measured by the OCPC method and serum inorganic phosphates was measured by the Takahashi method. Serum calcium levels showed a significant decrease 1 week after Px in all age groups. In these rats, serum CT levels showed a slight increase or no changes, and a significant increase in CT concentrations in the thyroid gland was observed in all age groups. Moreover, the increase in CT contents in the thyroid gland became larger 3 weeks after Px in rats operated on at one week of age. Thyroid extract containing 70 pg immunoreactive CT was effective in decreasing 1.22 mg/100 ml serum calcium at 15 min after i.v. injection in a bioassay system in which a dose response curve of human calcitonin was used as standards. Acute s.c. injection of CaCl2 solution resulted in a significant increase in serum CT levels 15 and 30 min later in intact 2- and 3-week-old rats, whereas no significant change in serum CT levels was observed in one-week-old intact rats. Three and 15 min after s.c. injection of Na2EDTA, serum Ca levels decreased markedly, but thyroidal CT contents tended to increase 3 and 5 min after the injection. The results indicated that parathyroidectomy in infantile rats induces a marked increase in biologically active calcitonin in the thyroid gland, inspite of the significant decrease of serum Ca levels.

Animals↗
PubMed1985

Surgical treatment of secondary hyperparathyroidism in patients with chronic renal failure: reevaluation of indications for parathyroidectomy.

On reviewing the preoperative clinical and laboratory findings and the surgical response seen in our series of 32 patients with renal hyperparathyroidism, the indication for parathyroidectomy was reevaluated. During the 5-year period from 1975 to 1979, parathyroid resection was performed in 9 patients who had various conditions for which surgery had been thought indicated. During the following period from January 1980 to March 1985, parathyroidectomy was carried out on 23 patients all of whom had roentgenologic evidence of generalized fibrous osteitis except for two whose indication for surgery was an elevation of the serum alkaline phosphatase level more than 45 KA units. The resected parathyroid glands had increased to 1 g or more in total weight in all the 25 patients who showed distinct postoperative improvement. Laboratory evidence indicating the presence of generalized fibrous osteitis, such as subperiosteal resorption on phalanx roentgenograms and high serum alkaline phosphatase level, along with marked elevation of the plasma immunoreactive parathyroid hormone level, proved to be a good indicator for medically uncontrollable secondary hyperparathyroidism. Fracture, heterotopic calcification, pruritus or persistent hypercalcemia was not a parameter of severe hyperparathyroidism warranting parathyroid resection, unless there was concomitant evidence of fibrous osteitis. The preoperative use of the recently developed noninvasive techniques for parathyroid localization also proved to be useful in detecting the parathyroid glands large enough to fulfill the requirements for parathyroidectomy.

Adult↗
PubMed1983

Parathyroidectomy for hyperparathyroidism in maintenance dialysis patients.

Parathyroidectomy was performed during a 5-year period in 11 of 196 patients undergoing maintenance dialysis for renal failure. Characteristics of the series were relatively long periods of dialysis, severe symptomatic bone disease, hypercalcemia, increased alkaline phosphatase, greatly raised serum levels of immunoreactive parathyroid hormone and X-ray changes appearing as abnormal bone structure, metastatic calcifications and pathologic fractures. Most of the operations consisted of total parathyroidectomy alone or accompanied by autotransplantation of parathyroid tissue. Subjective and objective improvement followed the operation in most cases, and the outlined indications thus appeared to be adequate. However, only a minority of the patients became symptom-free, and current methods of treating autonomic hyperparathyroidism in patients on regular dialysis must be regarded as suboptimal. The relative indications for the 2 types of operations are discussed. Total parathyroidectomy may be an acceptable operation for patients of this category.

Adult↗
PubMed2003

Optimization of the gamma probe-guided parathyroidectomy.

The objective of this study was to determine the patient-specific optimal time to surgery preoperatively to improve operative success in gamma probe-guided parathyroid localization. Fifteen patients with hyperparathyroidism underwent a double-phase Tc99m-MIBI (15-20 mCi) parathyroid scintigraphy to study the Tc99m-MIBI clearance kinetics from parathyroid and thyroid glands and to determine the time point at which the optimal target-to-background ratio was achieved. Optimal time to surgery was determined on the basis of the time at which the target-to-background ratio was maximal. On the day of surgery the patients received the same dose of Tc99m-MIBI and were taken to the operating room at the time of optimal target-to-background ratio. A four-gland exploration was performed with identification and excision of hot lesions using a gamma probe. Ex vivo lesion-to-background ratios were determined. Histopathologic confirmation of a successful parathyroidectomy was obtained intraoperatively by frozen section. The total operative time and the time to localize and excise the parathyroid glands were recorded. The mean surgery time was compared with that of previous parathyroidectomies performed by the same surgical team without use of preoperative scintigraphy and intraoperative gamma probe. Scintigraphy correctly localized parathyroid pathology in 12 of 15 (80%) patients. Intraoperative gamma probe was successful in 15 of 15 (100%). The optimal time to surgery was found to be different for each patient, and the mean time was calculated as 136 +/- 43 minutes. Mean surgery time for the excision of parathyroid gland was 91 +/- 46 minutes, which was significantly shorter than previous four-gland exploration without use of scintigraphy and gamma probe (160 +/- 61 minutes; t = 3.021, P = 0.007). The mean ex vivo lesion-to-background gamma probe count ratio of abnormal parathyroid glands (77.35) was found to be significantly higher than that of all other lesions with abnormal Tc99m-MIBI uptake (5.05) (U = 10.5, P < 0.0001). Optimal target-to-background ratio is essential for the success of gamma probe-guided parathyroidectomy. This ratio was highly variable among the patients in this study. Individualization of the best surgical exploration time after Tc99m-MIBI injection will improve the surgical success of this operation.

Adult↗
PubMed2002

[Clinical effect of parathyroidectomy for advanced renal hyperparathyroidism].

Advanced renal hyperparathyroidism induced not only osteitis fibrosa but also vessel and valvular calcification which affect high mortality due to cardiovascular disease. Parathyroidectomy usually promises dramatic clinical improvement of hyperparathyroidism. However, ectopic calcification except for tumor calcinosis is irreversible by parathyroidectomy. Then the surgery should be indicated at right time. Total parathyroidectomy with forearm autograft is suitable operative method for renal hyperparathyroidism, because removal of autograft can be less invasively performed at recurrence which is not negligible after the internal operation.

English Abstract↗
PubMed1989

Difficulties of parathyroidectomy after previous thyroidectomy.

Although the risks of reoperative thyroidectomy and parathyroidectomy have been well studied, the problems associated with parathyroidectomy after prior thyroidectomy have not been emphasized. Among a group of 282 patients who were treated for primary hyperparathyroidism in recent years at the University of Chicago Medical Center, 14 (4.8%) had undergone one or more previous thyroidectomies, and 6 others (2.1%) had undergone thyroid ablation with radioactive iodine as therapy for Graves' disease. Numerous difficulties were encountered during surgery in the postthyroidectomy group of patients as a result of scarring and fibrosis, prior recurrent laryngeal nerve injuries in 13%, the inability to known with certainty how many viable, normal parathyroid glands remained after previous operations, and the need for additional thyroid resection, mostly for associated malignant lesions. Preoperative vocal cord assessment, evaluation of prior operative and pathology reports, and localization studies with thallium-technetium scanning and ultrasonographic techniques were especially helpful. A "lateral approach" was used frequently during surgery. Each of these 14 patients was cured of the hyperparathyroidism. The postthyroid ablation group presented fewer intraoperative challenges, although in some patients the thyroid gland was virtually absent, which obscured the normal landmarks of the surgical field. Five of these six patients were cured of hyperparathyroidism. Parathyroidectomy after thyroidectomy presents many operative challenges to the surgeon and should be approached with the same care and concern that one reserves for a reoperative parathyroid operation.

Adult↗
PubMed1987

Clinical long-term results after parathyroidectomy for primary hyperparathyroidism.

The long-term clinical results of parathyroidectomy for primary hyperparathyroidism were analyzed in 176 patients. Preoperatively 152 patients (86%) showed classic symptoms, 15 (9%) were classified as minimally symptomatic (only hypertension, diffuse osteopenia or manifestations of the hypercalcemic syndrome), and nine (5%) were asymptomatic. All patients were normocalcemic at follow-up, but renal, skeletal or gastrointestinal symptoms were eliminated in only 88-91%. Preoperatively impaired renal function and hypertension were seldom improved by parathyroidectomy. Deterioration of renal function and hypertension occurred only in the symptomatic and minimally symptomatic patients, in whom the course was varied and unpredictable. During observation periods up to 22 years, 7% of the patients died of acute/chronic renal failure or consequences of hypertension. Death from uremia was more common when there was also skeletal involvement. Acute pancreatitis could occur without preoperative symptoms, but other gastrointestinal disorders responded to normalization of parathyroid metabolism. Multiple bone lesions responded functionally and lacked prognostic significance. Hypercalcemic syndrome was rapidly and lastingly relieved by parathyroidectomy.

Aged↗
PubMed1987

Trabecular and cortical bone in the radii of women with parathyroid adenomata: a greater trabecular deficit, with a preliminary assessment of recovery after parathyroidectomy.

Radial bone mineral content (BMC) has been reported to be lower than normal in patients with hyperparathyroidism, but those measurements have been made with techniques which do not discriminate between trabecular and cortical bone. We have used a low radiation dose computed tomography technique to make differential measurements of trabecular and cortical bone in the radii of 18 out of 27 eligible female patients with surgically proven adenomata. Prior to parathyroidectomy there was a mean deficit of 40% (P less than 0.001) in trabecular bone density in the distal radius, and a deficit of 16% in cortical bone in the radius mid-shaft compared to normal values. Seventeen months after parathyroidectomy there was a small but significant increase in trabecular bone density in the distal radius in 13 of these patients, and no significant change in cortical bone. If these results represented the situation throughout the skeleton, it is possible that parathyroidectomy may provide some reduction in future risk of fracture in women with primary hyperparathyroidism.

Adult↗
PubMed1977

Parathyroidectomy after renal transplantation.

Among 569 patients treated with renal transplantation during a 12-year period in Gothenburg, eleven patients were subjected to subtotal parathyroidectomy after successful transplantation. All patients had comparatively long histories of advanced renal failure and/or long-lasting haemodialysis treatment before transplantation. Signs of hyperfunctioning parathyroid glands (elevated total serum calcium with or without clinical symptoms) appeared within the first few months after transplantation in eight cases, and after 1-3 years in three cases. Four patients had symptoms of bone disease and/or soft tissue calcium deposits whereas renal functional impairment was not noted in any patient. The remaining seven patients were operated upon because of persistently elevated serum calcium levels only, in order to prevent such complications. In spite of our extremely restrictive policy concerning parathyroidectomy in patients awaiting renal transplantation and, conversely, a liberal attitude to this operation after transplantation, parathyroidectomy was a rare event among our patients. The rationale for surgical treatment of mild hyperparathyroidism following renal transplantation is questioned, as is the need for sophisticated diagnostic procedures to detect more cases of asymptomatic hyperparathyroidism.

Adult↗
PubMed1977

Explorative parathyroidectomy before and after kidney transplantation.

Twentytwo parathyroidectomies were performed in a series of about 200 patients. Surgical exploration was performed in less than 5% of patients with slowly progressive uremia, and of patients on maintenance haemodialysis, whereas as many as 15% of patients returning to dialysis after graft failure were operated on. After successful transplantation appoximately 10% of a patients with an initially functioning graft ultimately had a neck exploration. On three occasions this parathyroidectomy was acutely performed. In about one third of the surgically explored cases the parathyroid glands displayed marked assymetry and/or histological features possibly indicative of adenoma formation or "autonomous nodules". The incidence of surgical complications was low and beneficial clinical effect were often encountered. It thus seems possible to defend a liberal attitude towards the performance of parathyroidectomy in patients accepted into a transplantation programme.

Adult↗
PubMed1979

Uraemic myocardial disease. An experimental study, with special reference to the effect of parathyroidectomy.

A histopathological study of the myocardium was performed in rats made uraemic by a 5/6 kidney resection. The examinations were performed after intervals up to 36 weeks. Uraemia caused focal myocardial necroses, the incidence and severity of which were related to the length and severity of the uraemic state. In the myocardium of some animals intracellularly located calcifications were found. The calcifications usually appeared only in the necrotic areas. The coronary arteries showed only slight or moderate arteriosclerosis without severe obturation of the lumens and the genesis of the necroses is suggested to be factors other than ischaemia or hypoxia. Since secondary hyperparathyroidism might be one such factor, the effect of prior parathyroidectomy was studied. Parathyroidectomy prevented the development of calcifications but not the development of necrosis. However, the significance of secondary hyperparathyroidism in the development of myocardial necroses cannot be fully evaluated from the present study. The protecting effect of parathyroidectomy was probably counterbalanced by the deleterious effect of further elevated serum phosphate levels in the parathyroidectomized animals.

Adrenal Glands↗
PubMed1984

Subtotal parathyroidectomy for secondary hyperparathyroidism.

Controversy exists regarding the relative merits of subtotal parathyroidectomy (SPTX) versus total parathyroidectomy with autotransplantation in the treatment of secondary hyperparathyroidism (HPT). Fourteen patients who underwent SPTX for secondary HPT were evaluated to determine the efficacy of this treatment in view of modern dialysis, diet, and drug treatment. Indications for operation included intractable symptoms (two patients), progressive renal osteodystrophy (eight patients), or both (four patients). Duration of renal failure ranged from 3 to 15 years (mean 7.8 years) before SPTX. The operative serum calcium level was normal in 10 patients, elevated in three patients, and low in one patient. Preoperative parathyroid hormone (PTH) levels ranged from 3.9 to 144 ng/ml (average 41 ng/ml) and decreased after operation to an average of 3.6 ng/ml (normal PTH less than 1 ng/ml). There were no deaths or major postoperative complications. Clinical or radiographic improvement occurred in 80% of patients but did not correlate with absolute reductions in PTH levels. Our results reveal that SPTX is a simple and effective treatment in the initial surgical management of uremic, secondary HPT and appears to be comparable to those obtained with more complicated surgical approaches such as total parathyroidectomy and autotransplantation.

Adult↗
PubMed1983

Blood requirement and subtotal parathyroidectomy in patients with chronic renal failure treated with hemodialysis.

Six patients on maintenance hemodialysis underwent subtotal parathyroidectomy. In 3 patients with a "high" blood requirement before operation, a decrease, by at least 50%, was observed, while in 3 others with a "low need" for transfusion subtotal parathyroidectomy had no affect. Subtotal parathyroidectomy should be considered in hemodialysis patients with excessive need for blood transfusions.

Adult↗
PubMed1983

Successful parathyroid gland autotransplantation after total parathyroidectomy in dialysis patients.

Secondary hyperparathyroidism is one of the major complications encountered in patients on maintenance dialysis. Medical management is frequently unsuccessful, and there is often a need to perform a parathyroidectomy. Recurrent clinical secondary hyperparathyroidism may occur as a sequela of subtotal parathyroidectomy and necessitate a reexploration of the neck. Total parathyroidectomy followed by autotransplantation of parathyroid tissue into the patient's forearm bypasses the need for a second operation, and it provides a simple ambulatory procedure, under local anesthesia, for the removal of hyperplastic parathyroid tissue. The results in six patients indicate that this new procedure should be considered the treatment of choice for this condition.

Adult↗