Surgery for secondary hyperparathyroidism: mastering the anatomy – a single-center retrospective cohort study

TL;DR

This study shows that understanding the anatomy of parathyroid glands improves surgical success in treating a severe thyroid condition in dialysis patients.

Contribution

The study provides detailed anatomical localization data of parathyroid glands in SHPT patients, improving surgical guidance.

Findings

Preoperative imaging localized parathyroid glands in only 34.6% and 31% of cases using ultrasound and sestamibi scintigraphy.

76.6% of patients achieved normal iPTH levels post-surgery, showing high success rates with TPTx and BCTx.

Anatomical zones for gland localization proved more reliable than preoperative imaging methods.

Abstract

This study aimed to evaluate the anatomical localization and distribution of parathyroid glands following total parathyroidectomy (TPTx) and bilateral cervical thymectomy (BCTx) in chronic hemodialysis patients with medically refractory secondary hyperparathyroidism (SHPT).

A retrospective study on 154 consecutive SHPT patients with a mean hemodialysis duration of 109.3 ± 63.3 months was conducted.The study focused on the distribution of parathyroid glands within defined anatomical zones identified during surgery. Preoperative imaging methods (ultrasound and technetium-99 m sestamibi scintigraphy) provided limited diagnostic value, successfully localizing glands in only 34.6% and 31% of cases, respectively. Intraoperative parathyroid hormone (iPTH) measurement was not performed in any patient undergoing TPTx and BCTx.

Postoperative success was defined by the normalization of iPTH levels, with 76.6% of patients achieving normal iPTH levels on postoperative day one (mean: 12.2 ± 14.1 pg/mL). Persistent SHPT was identified in 36 patients, leading to five complementary parathyroidectomies. The study demonstrated that the anatomical zones defined for parathyroid gland localization are reliable, exhibiting higher accuracy compared to preoperative imaging.

The findings support the feasibility of achieving high success rates with TPTx for SHPT, even when preoperative diagnostic tools are limited or ineffective. Knowledge of parathyroid gland distribution within these anatomical zones can significantly assist endocrine surgeons, particularly those who approach this condition with hesitation.

Figures