Location of Abnormal Parathyroid Glands: Lessons from 810 Parathyroidectomies

• Published in: The Journal of surgical research Vol. 207; pp. 22 - 26
• Main Authors: LoPinto, Melissa, M.D., M.P.H, Rubio, Gustavo A., M.D, Khan, Zahra F., M.D, Vaghaiwalla, Tanaz M., M.D, Farra, Josefina C., M.D, Lew, John I., M.D., F.A.C.S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Follow-Up Studies; Humans; Hyperparathyroidism, Primary - pathology; Hyperparathyroidism, Primary - surgery; Male; Middle Aged; Negative parathyroid imaging; Parathyroid anatomy; Parathyroid gland localization; Parathyroid Glands - anatomy & histology; Parathyroid Glands - surgery; Parathyroidectomy; Primary hyperparathyroidism; Retrospective Studies; Surgery; Treatment Outcome; Young Adult; parathyroid gland localization; negative parathyroid imaging; primary hyperparathyroidism; parathyroid anatomy; parathyroidectomy; Primary hyperparathyroidism; Negative parathyroid imaging; Parathyroidectomy; Parathyroid anatomy; Parathyroid gland localization
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2016.08.045

Abstract Introduction Primary hyperparathyroidism (pHPT) is commonly treated with targeted parathyroidectomy (PTX) guided by preoperative imaging and intraoperative parathormone monitoring (IPM). Despite advanced imaging techniques, failure of parathyroid localization still occurs. This study determines the anatomical distribution of single abnormal parathyroid glands, which may help direct the surgeon in PTX when preoperative localization is unsuccessful. Methods A retrospective review of prospectively collected data of 810 patients with pHPT who underwent initial PTX at a tertiary medical center was performed. All patients had biochemically confirmed pHPT and single gland disease. Abnormal parathyroid gland localization was determined at time of operation, correlated with operative and pathology reports, and confirmed by operative success defined as eucalcemia for > 6 months after PTX. Patients with MEN, secondary, tertiary or familial hyperparathyroidism, multiglandular disease, parathyroid cancer and ectopic glands were excluded. Data were analyzed by Chi-squared and Z-test analyses. Results Among 810 patients who underwent PTX for pHPT, single abnormal parathyroid glands were unequally distributed among the 4 eutopic locations (left superior, 15.7%; left inferior, 31.3%; right superior, 15.8%; right inferior, 37.2%; p<0.01). Abnormal inferior parathyroid glands (68.5%) were significantly more common than abnormal superior glands (31.5%), respectively (p <0.01). In men, the most common location for single abnormal parathyroid glands was the right inferior position (43.4%, p<0.01). Overall, there was no significant difference in laterality. Conclusion This large series of patients suggests that single eutopic abnormal parathyroid glands are more likely to be inferior. In men, moreover, if an abnormal parathyroid gland is not localized preoperatively, the right inferior location should be explored first. Nevertheless, successful PTX remains predicated on knowledge of parathyroid anatomy, experience and judgement of the surgeon.