scholarly journals EXPERIENCE OF SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM

2016 ◽  
Vol 1 (4) ◽  
pp. 29-35
Author(s):  
Рожанская ◽  
Elena Rozhanskaya ◽  
Махутов ◽  
Valeriy Makhutov ◽  
Булгатов ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Thyroid Gland ◽  
Secondary Hyperparathyroidism ◽  
Central Neck Dissection ◽  
Parathyroid Glands ◽  
Superior Mediastinum ◽  
Simultaneous Surgery ◽  
Target Values ◽  
Cervical Approach ◽  
Gross Examination

Surgical treatment of secondary hyperparathyroidism (HPT) in patients having renal replacement therapy (RRT) is a current problem. The aim of our study was to optimize the treatment of secondary HPT based on the comparative analysis of effectiveness of the surgeries with different extents. We conducted a retrospective analysis of the results of surgical treatment of uremic HPT in 34 patients. 36 surgeries were performed including 34primary (16subtotal parathyroidecomies (PTE), 13total parathyroidecomies (total PTEI), 5total parathyroidecomies with central neck dissection and resection of superior mediastinum and superior thymus horns (total PTEII)) and 2repeated surgeries (total PTEII and parathyroidadenomectomy). Gross examination of 134 surgical specimens revealed dyssynchronous pathological changes in parathyroid glands (PTG), normal PTG structure was found in 2cases. Recurrent HPT was found in 3 cases, persistent HPT – in 9cases, hypoparathyroidism – in 5cases after subtotal PTE and in 9 cases after total PTE with autotransplantation (p=0,267). Target values of parathyroid hormone were registered in 8patients, including 4 patients after subtotal PTE and 4 patients after total PTE (p>0,95). Morbidity was similar in all types of surgeries (p>0,5). Analysis of morbidity determined that simultaneous surgery of thyroid gland increased the risk of laryngeal paralysis (р=0,028). The decrease in occurrence of secondary HPT persistence (with the source accessible for removal through cervical approach) at total PTE based on the removal of parathyroid glands of all localizations accessible through cervical approach (including thyroid gland lobes with diagnosed ectopia, central cervical fat pad, superior mediastinum and superior thymus horns) was registered (NNT=4).

scholarly journals Surgical Treatment of Secondary Hyperparathyroidism at Ectopic Parathyroid Gland in Anterior-Superior Mediastinum (Literature Review and Clinical Case)

2020 ◽  
Vol 5 (4) ◽  
pp. 84-89
Author(s):  
E. A. Ilyicheva ◽  
D. A. Bulgatov ◽  
A. V. Zharkaya ◽  
V. N. Makhutov ◽  
E. G. Grigoryev
Keyword(s):  
Chronic Kidney Disease ◽  
Surgical Treatment ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Clinical Case ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Special Equipment ◽  
Superior Mediastinum

Parathyroidectomy is the leading treatment for drug-refractory secondary and tertiary hyperparathyroidism in patients with chronic kidney disease. Difficulties in performing this surgery are mainly associated with the anatomical features of the parathyroid glands, in particular with the variability of their number and topographic anatomy. Ectopic parathyroid glands are one of the most common causes of persistence or recurrence of secondary hyperparathyroidism after surgery. One of the common variants of ectopia is the localization of the parathyroid gland in the anterior-superior mediastinum. The article discusses the features of surgical treatment of secondary hyperparathyroidism in patients with end-stage chronic kidney disease with this ectopia. A new method of treating hyperparathyroidism in patients with an atypical location of the parathyroid gland in the anterior-superior mediastinum is presented. This method is characterized by low invasiveness of access, ease of implementation without using special equipment and instruments. The proposed method was used in the treatment of a patient with secondary hyperparathyroidism due to chronic renal failure as a result of chronic glomerulonephritis. The duration of hemodialysis at the time of the surgery was more than 17 years. In the presented clinical case, ectopia of one of the pathologically altered parathyroid glands in the anterior-superior mediastinum was found at the preoperative stage. As a method of surgical treatment, we carried out total parathyroidectomy with autotransplantation of a fragment of parathyroid tissue into the brachioradialis muscle. Thanks to this method, it was possible to remove the atypically located parathyroid gland from the cervicotomy access and to discharge the patient within the standard terms for a given volume of surgery.

scholarly journals Analysis of the calcium-phosphorus metabolism and function of the parathyroid glands in patients with type 1 diabetes mellitus

2013 ◽  
Vol 16 (4) ◽  
pp. 33-37 ◽  
Author(s):  
Ekaterina Alexandrovna Khantakova ◽  
Larisa Yur'evna Khamnueva ◽  
Galina Mikhailovna Orlova
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Secondary Hyperparathyroidism ◽  
Calcium Metabolism ◽  
Parathyroid Glands ◽  
Phosphorus Metabolism ◽  
Target Values ◽  
Calcium Phosphorus

Objective. To analyze the calcium-phosphorus metabolism in patients with diabetes mellitus (DM) type 1 depending on the functional state of the kidneys. Materials and Methods. The study involved 235 patients with type 1 diabetic (males). One hundred and thirty-four patients entered the group without diabetic nephropathy (DN) and 101 patients entered the group with DN. To study the phosphorous-calcium metabolism in patients with type 1 diabetes there were studied the following parameters in blood plasma: the level of intact parathyroid hormone (PTH), total calcium (Ca), ionized calcium (Ca2+), serum phosphorus (P), as well as calculated CaxP product. Results.  In patients with type 1 diabetes in the progression of DN the increase of P was observed from stage 4 CKD and reduction of Ca ? from CKD stage 5. The increase of the level of PTH was observed from the stage of CKD 3, although isolated cases of secondary hyperparathyroidism were registered in patients with stage CKD 2. At the same time in a large group of the patients with type 1 diabetes there was observed level of PTH below the target values of the stages CKD 3, 4, 5. The deterioration of glycemic control in patients with type 1 diabetes is associated with decreased level of PTH. In patients with type 1 diabetes without DN and with DN there was observed inverse relationship between the level of glycated hemoglobin (HbA. 1c). Conclusion. In patients with type 1 diabetes the progression of DN leads to various disorders of phosphorus-calcium metabolism: reduction of Ca, higher level of P, alter the function of the parathyroid glands (secondary hyperparathyroidism and reduction of PTH below the target value). Deterioration of glycemic control in patients with type 1 diabetes is associated with a reduction of PTH.

scholarly journals Surgical treatment of patients with secondary hyperparathyroidism in chronic renal failure

2003 ◽  
Vol 49 (6) ◽  
pp. 36-41
Author(s):  
V. N. Smorshchok ◽  
N. S. Kuznetsov ◽  
A. M. Artemova ◽  
L. Ya. Rozhinskaya ◽  
D. G. Beltsevich
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Secondary Hyperparathyroidism ◽  
Clinical Laboratory ◽  
Intraoperative Ultrasound ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Subtotal Parathyroidectomy ◽  
Ultrasound Study ◽  
Made In

The purpose of the study was to define indications for surgical treatment and its scope in patients with secondary hyperparathyroidism in the presence of end-stage chronic renalfailure. The authors examined 80 patients who had a history of long-term procedures of hemo- or peritoneal dialysis. The patients’ mean age was 47±3.2 years. Measurements of the levels of alkaline phosphatase, ionized and total calcium, phosphorus, parathyroid hormone, ultrasound of the parathyroid glands, densitometry and X-ray study were made in all the patients. All the patients received alfacalcidole therapy during different periods of time. Clinical, laboratory, and morphological correlations were made to establish indications for surgical treatment. The sensitivity ofpreoperative ultrasonography was 72.5% and that of intraoperative ultrasound study was as high as 98.4%. The sensitivity of intraoperative revision was 75%. Sixteen of the 20 patients operated on underwent total parathyroidectomy by autografting a fragment of one of the least glands into the muscle. Subtotal parathyroidectomy was made in 3 patients; 3 parathyroid glands were removed in 1. Emergency and planned studies were performed in all the patients. The duration of the patients operated on averaged 14 months. Three patients undergone total parathyroidectomy with autografiing developed signs of hyperparathyroidism following 6, 12, and 13 months, in this connection graft resection was made in these patients. In the follow-up periods of 3 to 6 months, the level of parathyroid hormone became normal after resurgery in 2 of these patients, hypoparathyroidism developed in one patient. Two months after surgery, recurrent secondary hyperthyroidism was detected in 2 of the 3 patients who had undergone subtotal parathyroidectomy (4 and 7 months after the occurrence of signs of transient hypoparathyroidism) and in 1 patient in whom 3 parathyroid glands had been removed. Four of the 20 patients operated on were observed to have hypoparathyroidism that was compensated by calcium preparations and active forms of vitamin D3. Thus, a good result was noted in 70% of the patients after surgical treatment.

scholarly journals Multiglandular Parathyroid Disease: the Results of Surgical Treatment

2020 ◽  
Vol 5 (4) ◽  
pp. 90-97
Author(s):  
E. A. Ilyicheva ◽  
G. A. Bersenev ◽  
A. V. Zharkaya ◽  
D. A. Bulgatov ◽  
V. N. Makhutov
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Primary Hyperparathyroidism ◽  
Secondary Hyperparathyroidism ◽  
Intraoperative Monitoring ◽  
Parathyroid Glands ◽  
Bilateral Neck Exploration ◽  
Neck Exploration ◽  
Multiple Lesions ◽  
Multiple Gland Disease

Background. Sporadic multiple gland disease in primary hyperparathyroidism occurs in 7 to 33 % of cases. The absence of specific risk factors, low sensitivity of imaging methods, and low efficiency of bilateral neck exploration and intraoperative monitoring of parathyroid hormone indicate the complexity of the diagnosis and treatment of this disease’s form. Aim of the research. To analyze the results of surgical treatment of multiple lesions of the parathyroid gland in primary and secondary hyperparathyroidism. Methods. There was retrospective study, which included 100 observations of surgical treatment for primary and secondary hyperparathyroidism in the thoracic department of Irkutsk Regional Clinical Hospital from May 2018 to September 2019. The main point was to identify the frequency of surgical treatment outcomes in patients with multiple parathyroid lesions. As part of the study, potential predictors of multiple gland disease in primary hyperparathyroidism were analyzed. Results. Multiple gland disease in primary hyperparathyroidism occurs in 29 % of cases and causes persistence of the disease (p ≤ 0.01). Signs of multiple gland disease in primary hyperparathyroidism include the level of ionized calcium, parathyroid hormone (p ≤ 0.05), creatinine level and glomerular filtration rate (p ≤ 0.01). A negative result of intraoperative monitoring correlates with persistence of primary hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05). Selective parathyroidectomy is associated with persistence of hyperparathyroidism in multiple lesions (χ2, p ≤ 0.05), while total parathyroidectomy is associated with remission of the disease (χ2, p ≤ 0.05). We did not find a statistically significant relationship between the results of surgical treatment for morphology of the parathyroid glands (χ2, p > 0.1). Conclusion. Multiple gland disease is the main cause of persistence of primary hyperparathyroidism. This form of the disease corresponds to lower levels of calcium, parathyroid hormone, and kidney function. Persistence factors have been established: removal of less than four parathyroid glands and a negative result of intraoperative monitoring of parathyroid hormone. Bilateral neck exploration does not reduce the incidence of disease persistence.

scholarly journals Parathyroidectomia: treatment of secondary hyperparathyroidism. Causes and prophylaxis of disease relapse

2011 ◽  
Vol 18 (4) ◽  
pp. 170-174
Author(s):  
V. BEIŠA ◽  
K. LAGUNAVIČIUS ◽  
A. BEIŠA ◽  
K. STRUPAS
Keyword(s):  
Parathyroid Hormone ◽  
Surgical Treatment ◽  
Secondary Hyperparathyroidism ◽  
Parathyroid Gland ◽  
Ultrasound Examination ◽  
Single Photon ◽  
Photon Emission ◽  
Parathyroid Glands ◽  
Emission Computed Tomography ◽  
Mibi Scintigraphy

Background. The growing number of haemodialysis patients and the increasing their life expectancy within the past few years have resulted in a rise of long-term haemodialysis-associated complications. The aim of the paper is to present a case study of a successful surgical treatment of secondary hyperthyroidism and assess the causes of the disease. Materials and methods. A 63-year-old male patient had been on haemodialysis for 18 years; he had undergone parathyroidectomy for secondary hyperparathyroidism 10 years ago. The relapse of the disease was suspected when the patient developed the onset of pruritus and muscle pain. The following tests were performed: biochemical markers of plasma calcium and parathyroid hormone, thyroid ultrasound examination, parathyroid gland 99 mTc MIBI scintigraphy, single photon emission computed tomography of the neck and mediastinum. Results. Elevated calcium (2.73 mmol/l serum) and parathyroid hormone (1352 pg/ml blood plasma) levels were found. Ultrasound examination, 99 mTc MIBI scintigraphy and SPECT revealed parathyroid adenoma of the left inferior thyroid section. The patient underwent surgery in 2011. Remnants of the previously resected parathyroid gland were removed, and an accessory parathyroid gland was found within the thymus; this gland was removed, and partial autotransplantation was performed. The level of the parathyroid hormone decreased to 24 pg/ml during the day after surgery. The histological examination of the removed tissues was performed. Conclusions. Accessory parathyroid glands are usually found within the thymus; therefore, any type of surgical treatment of secondary hyperparathyroidism should include thymectomy. Keywords: parathyroid glands, secondary hyperparathyroidism, haemodialysis, parathyroidectomy

Surgical treatment of metastatic disease in the thyroid gland

1981 ◽  
Vol 17 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Mats Ericsson ◽  
Ander Biörklund ◽  
Ebbe Cederquist ◽  
Stig Ingemansson ◽  
Måns Åkerman
Keyword(s):  
Surgical Treatment ◽  
Thyroid Gland ◽  
Metastatic Disease
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