Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

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de Menezes Montenegro, Fabio Luiz ; Lourenco Junior, Delmar Muniz ; Tavares, Marcos Roberto ; Arap, Sergio Samir ; Nascimento Junior, Climerio Pereira ; Massoni Neto, Ledo Mazzei ; D'Alessandro, Andre ; Toledo, Rodrigo Almeida ; Coutinho, Flavia Lima ; Brandao, Lenine Garcia ; de Britto e Silva Filho, Gilberto ; Cordeiro, Anoi Castro ; Almeida Toledo, Sergio Pereira

• Document type: Journal article
• Source: Clinics; v. 67, p. 9-pg., 2012-01-01.

Abstract

Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1. (AU)

• FAPESP's process: 09/15386-6 - Analysis of the CDKN1A, CDKN1B, CDKN2B and CDKN2C genes in multiple endocrine neoplasias type 1 and 2.
• Grantee: Rodrigo de Almeida Toledo
• Support Opportunities: Scholarships in Brazil - Post-Doctoral