Surgical tactics of parathyroidectomy: Should we abandon the use of ioPTH?

• Published in: The American journal of surgery Vol. 235; p. 115709
• Main Authors: Gómez-Ramírez, Joaquín, Arranz Jiménez, Raquel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2024; Elsevier Limited
• Subjects: Endocrine system; Humans; Hyperparathyroidism; Laparoscopy; Localization; Magnetic resonance; Mediastinum; Parathyroid; Parathyroid gland; Parathyroidectomy; Parathyroidectomy - methods; Patients; Pharynx; Success; Surgeons; Surgery; Thymus; Thymus gland; Thyroid; Thyroid gland; Tomography; Tumors; Ultrasonic imaging; Veins & arteries
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.03.005

The upper parathyroid glands originate from the fourth pharyngeal pouch, and the lower ones from the third, along with the thymus. [...]it is possible to find some of the lower parathyroids inside the thymus or even in the anterior mediastinum, while the upper ones can migrate to the posterior mediastinum (Fig. 1).1 The ectopic location of a pathological parathyroid gland is a common cause of parathyroidectomy failure and persistent hyperparathyroidism. [...]pathological glands can be located retroesophageally, retrocarotid, retrojugular, in the upper thyroid pole extension, in the posterior mediastinum, in the thymus extension, or in the anterior mediastinum. There are other methods like, magnetic resonance, or even venous sampling, which can be helpful on occasions but should not be first-line or sole determinants for selective surgery. On the one hand, the sensitivity of imaging methods is excellent today, approaching 90–95% in cases where multiple imaging tests coincide. [...]if the adenoma is removed during surgery at the position indicated by these tests (intraoperatively confirmed), the additional benefit of ioPTH may be marginal.