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PubMed1988

A case with persistent nephrogenic diabetes insipidus following parathyroidectomy for hyperparathyroidism.

A 25-year-old woman with persistent nephrogenic diabetes insipidus (NDI) following parathyroidectomy for primary hyperparathyroidism is described. NDI is a well recognized complication of primary hyperparathyroidism, generally imputed to hypercalcemia, and promptly reversible after correcting it. In our case, the impaired concentrating ability of the renal tubule was irreversible after the removal of the parathyroid adenoma and the correction of the hypercalcemia, presumptively due to the morphological irreversible changes in the kidney. In addition, hypercalciuria persisted and was the cause of a compensatory hyperparathyroidism. Treatment with thiazide diuretic was effective to decrease relative hypercalciuria, thus reversing the compensatory hyperparathyroidism.

Adenoma↗
PubMedDate not supplied

Superior thyroid artery lesion after US-guided chemical parathyroidectomy: angiographic diagnosis and treatment by embolization.

A 71-year-old woman presented with a life-threatening thyroid hemorrhage after US-guided chemical parathyroidectomy. The diagnosis was made by angiography followed by immediate embolization of a pseudoaneurysm of the left superior thyroid artery. Embolization controlled the hemorrhage, obviating the need for surgery. The patient made a full recovery with no evidence of further hemorrhage. Pseudoaneurysm of the superior thyroid artery is a rare cause of hemorrhage and percutaneous embolization is an effective method of treatment.

Aged↗
PubMed1982

Parathyroidectomy. Review of 338 consecutive cases for histology, location, and reoperation.

Three hundred thirty-eight consecutive parathyroidectomies for hyperparathyroidism were performed over a 22 year period. There were 53 dialysis patients (31 male and 22 female), 285 patients (165 female and 120 male) with primary hyperparathyroidism, 55 patients (19 percent) with parathyroid hyperplasia, and 230 patients with 236 parathyroid adenomas. The location of the adenomas were right upper in 57, right lower in 59, left upper in 60, and left lower in 60. Forty-three patients of the last 194 operated on had histories of childhood head and neck irradiation (21.6 percent), 34 patients (79.6 percent) had associated thyroid disease, and there were 10 with thyroid carcinomas. In the 285 patients, 54 percent had thyroid disease, and 18 had thyroid carcinomas. Twenty-three patients required reoperation for persistent or recurrent hypercalcemia, and 19 neck reexplorations and 6 mediastinotomies were performed. The identification and biopsy as indicated of all four parathyroid glands at initial neck exploration would have prevented over 70 percent of reoperations.

Adenoma↗
PubMed1983

Effect of parathyroidectomy on plasma calcium levels in the seal salamander, Desmognathus monticola.

The parathyroid glands of Desmognathus monticola are located in the subdermal connective tissue of the neck. Although they are smaller than previously described urodele parathyroid glands, their histological structure is similar. Parathyroidectomy caused a decrease in plasma calcium concentrations within 4 days following the operation. By Days 12 and 21, however, the plasma calcium levels of parathyroidectomized animals were not significantly different from those of sham-operated animals. Thus, the parathyroid gland of this species contains a hypercalcemic principle, but the recovery from hypocalcemia suggests that some hypercalcemic mechanism other than the parathyroid system must be involved in calcium homeostasis.

Age Factors↗
PubMed1988

Effects of thyroidectomy, parathyroidectomy and lithium on circadian wheelrunning in rats.

Circadian rhythms and levels of wheelrunning were studied in thyroidectomized, parathyroidectomized, thyro-parathyroidectomized, and sham-operated male rats. Animals were entrained to a 12:12 light:dark schedule, then exposed to constant dim red illumination, and then given a diet containing lithium. Under constant conditions, free-running circadian activity rhythms were shorter, and levels of activity were greater, in thyroidectomized and thyroparathyroidectomized animals. Lithium reversed these effects, lengthening free-running circadian periods in all groups, with a greater reduction of activity observed in animals with thyroids removed. Parathyroidectomy had no clear effects. Since lithium slowed circadian rhythms and reduced activity even in the absence of intact thyroid or parathyroid glands, these effects may have been due to the action of lithium at some other site. The same may be true of other thyroid suppressors reported to affect circadian rhythms. These findings may be relevant to the biological substrates of major affective disorders in humans, which have been associated with abnormalities of thyroid function, abnormally short circadian rhythms, abnormal activity levels, and responsiveness to lithium therapy.

Animals↗
PubMed2003

Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism.

BACKGROUND: To date there have been no reports on the feasibility of radioguided parathyroidectomy (RGP) in patients with secondary and tertiary hyperparathyroidism. METHODS: Twenty-three consecutive patients with secondary (n=5) or tertiary hyperparathyroidism (n=18) underwent RGP. Patients were injected with 10 mCi of technetium 99-sestamibi before surgery. All parathyroid glands were localized during operation with a neoprobe. RESULTS: The mean patient age was 50+/-3 years. The mean preoperative calcium and intact parathyroid hormone levels were 11.0+/-0.3 mg/dL and 400+/-107 pg/mL, respectively. Eighteen patients had 3- or 4-gland hyperplasia, 2 had double adenomas, 2 had forearm graft hyperplasia, 1 had 6-gland disease, and 3 had ectopic glands. All hyperplastic glands had ex vivo counts >20% of background (mean, 63%+/-6%), making frozen section unnecessary. When compared with 66 historical control subjects who underwent surgery without radioguidance for tertiary hyperparathyroidism, patients undergoing RGP had decreased operative times (96+/-8 minutes vs 151+/-15 minutes; P<.001) and lengths of stay (1.3+/-0.1 days vs 3.7+/-0.3 days; P<.001). CONCLUSIONS: RGP in patients with secondary and tertiary hyperparathyroidism is feasible, may reduce operative time, and permits omission of frozen section. Thus RGP appears to be a useful adjunct in the treatment of secondary and tertiary hyperparathyroidism.

Case-Control Studies↗
PubMedDate not supplied

[Indications and results of parathyroidectomy in the treatment of hyperparathyroidism in dialyzed and kidney transplant patients. Apropos of 68 cases].

Between 1972 and 1985, 78 parathyroidectomies were performed in 60 patients under chronic haemodialysis and in 6 recipients of renal transplants. These patients had severe hyperparathyroidism and radiological evidence of fibrous osteitis. This series shows a recrudescence of tertiary hyperparathyroidism in renal transplant recipients under ciclosporin. The post-operative course was favourable in 55 cases; 13 patients had to be reoperated upon, revealing the presence of supernumerary glands in 6 of them.

Adult↗
PubMed1986

Serum lipoprotein disturbances in primary and secondary hyperparathyroidism and effects of parathyroidectomy.

Serum lipoprotein disturbances were studied in 86 patients with primary (I), and 34 hemodialysis patients with severe secondary (II), hyperparathyroidism (HPTH) before and seven to 14 days after parathyroidectomy (PTx). In addition, a subset of patients had repeat studies more than 12 months after PTx. In patients with I as well as with II HPTH, mean +/- SEM fasting serum concentrations of total triglycerides (TG) (1.51 +/- 0.09 and 2.17 +/- 0.19 mmol/L, respectively) were significantly increased when compared with that of 22 age- and sex-matched healthy control subjects (1.01 +/- 0.09 mmol/L, P less than .001). No consistent anomalies of serum total cholesterol and lipoprotein cholesterol content were observed in Io HPTH patients. In uremic II HPTH patients, the cholesterol content of high-density lipoprotein (HDL) was significantly (P less than .01) depressed, compared with normal subjects. In the short term, PTx normalized serum total TGs (P less than .001) in Io HPTH patients from 1.50 +/- 0.11 to 1.19 +/- 0.07 mmol/L seven days after PTx. The surgical correction of II HPTH in dialysis patients was also followed by an improvement of hypertriglyceridemia from 2.22 +/- 0.21 to 1.46 +/- 0.08 mmol/L and 1.46 +/- 0.09 mmol/L seven and 14 days, respectively, after PTx (P less than .01). Long-term follow-up after PTx shows clearly a persistent decrease in serum TG concentration in I HPTH patients (1.17 +/- 0.11 mmol/L), as well as in II HPTH patients (1.61 +/- 0.18 mmol/L), 12 months after PTx by comparison with values determined before PTx.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1985

Increased bone aluminum deposition after subtotal parathyroidectomy in dialyzed patients.

Ten dialyzed patients underwent a systematic bone biopsy before and 19 +/- 9 months after subtotal parathyroidectomy (PTX). At the end of the follow-up period all the patients, except two, who complained of proximal myalgia, were asymptomatic. Compared to the bone biopsy specimen obtained prior surgery, decreased bone formation without mineralization impairment was observed after PTX. Despite an average decrease in aluminum gels intake after PTX, an increase in stained aluminum was observed (0.69 +/- 0.79 versus 1.20 +/- 0.95 mm/mm2, P less than 0.050). Aluminum accumulation depended on the pre-PTX bone aluminum load: pre- and post-PTX bone aluminum loads were correlated (r = 0.78, P less than 0.01). Bone aluminum accumulation was not related to the amount of aluminum gel intake after PTX; however, only two patients free of both bone aluminum deposit prior to PTX and aluminum gel intake after PTX had no stainable aluminum on the second bone biopsy after PTX. The only patient who had no decrease in bone formation after PTX had no increase in bone aluminum. Assuming that the patients had no aluminum deposit prior to dialysis, we measured the rate of bone aluminum accumulation. It rose from 0.11 +/- 0.09 mm/mm2/year prior to PTX to 0.40 +/- 0.25 mm/mm2/year after PTX (P less than 0.05) in the six patients who were maintained on phosphate binders and who had a decrease in bone formation after PTX. These six patients had unchanged aluminum gel intake.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Elective total parathyroidectomy without autotransplant in end-stage renal disease.

Ten patients are reported following parathyroidectomy (PTX). In 9 all identifiable parathyroid tissue in the neck was deliberately removed, and in the tenth (operated 14 years ago) the remnant which had been left probably did not function. Their post-operative course resembled that of patients treated conventionally, and their subsequent course was likewise uneventful with disappearance of all symptoms associated with their osteodystrophy. All patients required oral calcium supplementation but none were given vitamin D compounds after the initial period of repletion following surgery. Mean serum values were (before PTX and current) for calcium 2.63 +/- 0.14 and 2.33 +/- 0.08 mmol/liter, P = NS, for phosphorus 1.96 +/- 0.13 and 1.38 +/- 0.09 mmol/liter, P less than 0.01, and for alkaline phosphatase 713 +/- 191 and 101 +/- 14 IU, P less than 0.05. Evidence for residual parathyroid tissue was present in each case; one patient remained mildly hyperparathyroid and several were mildly hypoparathyroid by the IRMA PTH assay. Bone histomorphometry in five subjects post-PTX showed either normal or low turnover. Radiologically, striking remineralization was seen with disappearance of all erosive changes. We suggest that residual areas of parathyroid tissue are stimulated and continue to secrete hormone even when all the discrete glands have been removed. It is recommended that when indicated, and in the absence of aluminum excess, total PTX without autotransplant should be the preferred form of therapy for long-term dialysis patients.

Adult↗
PubMed1989

Short-term effects of parathyroidectomy on plasma biochemistry in chronic uremia.

Parathyroidectomy (PTx) is indicated in hemodialysis (HD) patients who have severe osteitis fibrosa unresponsive to vitamin D therapy or in whom the latter treatment is contraindicated. Immediately after PTx, plasma immunoreactive parathyroid hormone, calcium and phosphorus concentrations decline abruptly. However, little is known in such patients about the short-term effects of PTx on plasma alkaline phosphatase (AP) activity and plasma aluminum (Al) levels. The present, preliminary study was performed to determine such parameters in 37 HD patients, and to correlate them with data of bone histology. Mean plasma AP activity started to increase after PTx from day 4 onwards. Thus, AP values significantly higher than pre-PTx values were observed at day 7 and 14 (415 +/- 54 vs. 619 +/- 77 and 749 +/- 83 IU/liter, means +/- SEM; N = 37; P less than 0.05 and 0.001, respectively). This increase, in the absence of changes in liver function, was mainly due to the bone-specific iso-AP. Moreover, the degree of increase in plasma AP activity was higher in the subgroup with negative (group I, 21 patients) than in that with positive bone Al staining (group II, 16 patients). However, plasma osteocalcin (BGP) did not change after PTx (N = 8). Basal plasma Al levels were significantly higher in group II both before and two weeks after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Alkaline Phosphatase↗
PubMed1986

Parathyroidectomy, cardiovascular reactivity and calcium distribution in aorta and heart of spontaneously hypertensive rats.

In order to elucidate the mechanisms by which parathyroidectomy (PTX), performed in young spontaneously hypertensive rats (SHR), delays the development and attenuates the level of hypertension, we studied, in vivo, cardiovascular reactivity (CVR, blood pressure response to bolus noradrenaline administration), aortic calcium distribution and cardiac calcium content in SHR with or without parathyroid glands. PTX was performed in 6-week-old animals and experiments were done in pretreated anaesthetized animals 2 and 22 weeks after surgery. A significantly decreased CVR was observed 22 weeks after PTX in SHR-PTX as compared with controls. These data are not specific for hypertensive animals since similar data are also obtained on normotensive Wistar rats treated in an identical fashion. In addition, after PTX in SHR and Wistar rats myocardial (auricle and ventricle) calcium content was more rapidly reduced (after 2 weeks) than aortic membrane-bound and cellular calcium fractions. The present studies established that PTX decreased CVR and alters calcium content and distribution in the cardiovascular systems of rats from hypertensive and normotensive strains. Furthermore, the results confirm a requirement for the parathyroid glands in the pathogenesis of spontaneous hypertension in SHR and for the normal CVR.

Animals↗
PubMed1986

Effects of parathyroidectomy in pregnant rats on the luteinizing hormone and follicle-stimulating hormone response to synthetic luteinizing hormone-releasing hormone in the infantile offspring.

Effects of parathyroidectomy (PTx) in the rat at the 5th day of gestation on the functional development of gonadotrophin secretion in the infantile offspring was examined. A single subcutaneous injection of 10 micrograms/kg of luteinizing hormone-releasing hormone (LHRH) induced a significant increase in serum follicle stimulating hormone (FSH) and luteinizing hormone (LH) in control- and PTx-F1 male and female rats already at 3 days of age. The response in female rats was greater than in males at all ages examined. In the control- and PTx-F1 rats, age-related increase in the responsiveness to LHRH was observed in both sexes for LH but only in females for FSH. However, LH and FSH release by LHRH in the PTx-F1 female rats was significantly lower than that in control females at 14 and 22 days of age. In the PTx-F1 male rats, only FSH response to LHRH showed a tendency to decrease at 22 days of age. Serum calcium levels in 3-day-old PTx-F1 male and female rats were significantly lower than those in controls but only a slight decrease was observed in the PTx-F1 rats at other ages. The present results indicated that a low serum calcium environment during fetal life in the rat affects the functional development of pituitary responsiveness to LHRH, particularly in females.

Animals↗
PubMed1989

Aluminium accumulates on inactive bone surfaces after parathyroidectomy in uremic rats.

In recent studies on bone biopsies of long-term hemodialyzed patients, parathyroidectomy (PTx) has been shown to represent a risk factor for subsequent accumulation of aluminium (Al) in the bone. Therefore, the influence of late PTx on Al metabolism in uremic rats previously given 11 mg Al intraperitoneally during a period of four weeks was studied. Al content was determined in the blood, liver, bone and feces 7 and 14 days after PTx. During PTx, each animal also received 2 intramuscular implants of partially demineralized bone matrix cylinders, which served as inactive bone surfaces. In PTx animals, the Al content in the liver, spleen and kidney progressively decreased, while its blood levels increased in spite of the fact that the treatment was stopped. Bone values remained unchanged but Al markedly accumulated on inactive mineralized surfaces of implanted cylinders. Significant amounts of Al in fecal masses could indicate its biliary excretion. The results were influenced neither by changes in 1,25-(OH)2D3 or serum calcium values, nor by different degrees of renal failure after PTx. It is suggested that accumulation of Al in the bone after PTx, as found in dialyzed patients, constitutes a passive event triggered by inactive bone tissue.

Aluminum↗
PubMed1984

Intraoperative urinary cyclic adenosine monophosphate as a guide to successful reoperative parathyroidectomy.

Sixty patients with persistent or recurrent primary hyperparathyroidism underwent reexploration during which urinary cyclic adenosine monophosphate (UcAMP) levels were determined at half-hour intervals by radioimmunoassay. Retrospective analysis of the data allowed us to develop UcAMP criteria for surgical success. Following removal of parathyroid tissue, if an individual UcAMP level dropped 50% from the median baseline level, or if elevated levels dropped to less than 4.0 nmol/dl glomerular filtrate, surgery was predicted to be successful. Eight unsuccessful procedures in seven patients produced no decline in UcAMP, and the intraoperative results accurately predicted surgical failure. Fifty-three patients underwent successful procedures and in every case UcAMP fell. Ninety-eight per cent of these successful procedures were predicted by our criteria. Levels of UcAMP fell 1.5 +/- 0.5 hours (means +/- SD) following abnormal parathyroidectomy. In 19 of 36 successful cases diagnosed before surgery as adenoma, the operative procedure was terminated before a significant drop in UcAMP. In 16 of 17 successful cases diagnosed before surgery as hyperplasia or uncertain histology, UcAMP fell during the operation. Intraoperative determination of UcAMP is helpful in reoperative parathyroid surgery. The criteria established allow intraoperative prediction of success with remarkable accuracy. Urinary cyclic AMP is especially helpful in reoperation for multigland disease; when enough pathologic tissue has been removed, the criteria will be met and the procedure may be terminated with confidence.

Cyclic AMP↗
PubMed1986

Vocal cord paralysis and reoperative parathyroidectomy. A prospective study.

One hundred sixty-three patients undergoing reoperative parathyroidectomy were evaluated before and after operation to determine the incidence of, risk factors for, and morbidity of vocal cord paralysis. These patients were compared to 77 patients undergoing initial parathyroid operation, only one of whom had vocal cord paralysis on postoperative indirect laryngoscopy (1.3%). Preoperative examination of the reoperative patients revealed vocal cord paralysis from initial exploration in 11 patients who were excluded from this study. After re-exploration, 10 patients (6.6%) had vocal cord paralysis, eight unilateral and two bilateral. Right vocal cords were paralyzed twice as often as left. In 90%, vocal cord paralysis was associated with removal or biopsy of an ipsilateral gland. Vocal cord paralysis occurred despite intraoperative visualization of the recurrent laryngeal nerves. Preoperative localization, parathyroid gland pathology, and concomitant thyroidectomy were not associated with increased risk of vocal cord paralysis. Hoarseness was the major symptom. Tracheostomy was required for two patients, one was permanent. One patient was treated for aspiration with a temporary gastrostomy. Nine of 10 patients had return of normal voice quality in an average of 4 months time. On examination 4 years or more after surgery, two of five patients had normal vocal cord motion. The oblique anatomic course of the right recurrent laryngeal nerve may account for the greater frequency of right vocal cord paralysis.

Follow-Up Studies↗
PubMed1988

Total parathyroidectomy with forearm autograft for secondary hyperparathyroidism in chronic renal failure.

One hundred twenty-eight patients with chronic renal failure and secondary hyperparathyroidism underwent total parathyroidectomy with forearm autograft. Postoperative clinical improvement was remarkable. In all cases, the grafted tissue functioned well, and reimplantation of the cryopreserved parathyroid tissues was unnecessary. Intact 1-84 parathyroid hormone was more sensitive than C-terminal parathyroid hormone in parathyroid hormone level (PTH) gradient assays of grafted and nongrafted forearm. The study of hypocalcemia was also helpful in obtaining more distinct PTH gradients. Five of 119 patients had supernumerary parathyroid glands (4.2%), which preoperative noninvasive image diagnosis of parathyroid glands was helpful in detecting.

Adult↗