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Understanding Parathyroid Diseases and Surgery

The document discusses parathyroid diseases, including the anatomy, function, and risk factors associated with parathyroid glands. It outlines diagnostic procedures, treatment options, and complications related to parathyroid surgery, as well as the management of parathyroid cancer. Key points include the importance of biochemical diagnosis and the role of imaging studies in surgical planning.

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Ibrahim
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37 views50 pages

Understanding Parathyroid Diseases and Surgery

The document discusses parathyroid diseases, including the anatomy, function, and risk factors associated with parathyroid glands. It outlines diagnostic procedures, treatment options, and complications related to parathyroid surgery, as well as the management of parathyroid cancer. Key points include the importance of biochemical diagnosis and the role of imaging studies in surgical planning.

Uploaded by

Ibrahim
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Parathyroid Diseases

Dr. Manal Ali Salem


Breast and Endocrine Surgical Oncology
King Fahad Medical city
Introduction
o 4 Parathyroid glands are located posterior to thyroid
gland
o Yellow or brown, oval, 3-7 mm, 30-40 mg
o It is the last gland discovered in human by a Swedish
medical student called Ivar Sandstorm
o Secrete parathyroid hormone (PTH which regulates
calcium metabolism)
o Parathyroid hormone PTH is a 84 AA polypeptide that
is secreted from parathyroid gland
o It regulates calcium metabolism.
Risk Factors:
o H/O irradiation
o Lithium
o Genetic

Fact:
o F:M 3:1
o The most common cause of outpatient hypercalcemia
MEN Syndromes
Initial work up
o PTH, Ca, Vit D
o Renal function
o 24 hs urine collection for Ca
o Bone Scan
o US/CT Renal

The diagnosis is entire BIOCHEMICAL


High PTH
with high Ca with normal vit D: Classical PHPT
Asymptomatic pts who does not meet
the criteria

• Medical surveillance
• Annual clinical and biochemical evaluation (PTH, Ca,
RFT)
• Bone scan every 1-2 years
DDx of PHPT
Preop Localization
1- Non invasive ( Radiology )
o The aim NOT to diagnose ( Dx is Biochemical )
o The aim is to assist the surgeon in planning the proper surgery
o Definition of localization study: TWO CONCORDANT STUDY
o Negative image does NOT rule out the Dx
o US + sestamibi ( most common two)

2- Invasive
o Only in redo parathyroidectomy
BNE principles

1- Identify all normal and abnormal parathyroid glands


( PTG).
2- Distinguish between single-gland and multi glandular
disease (MGD)
3- Resect abnormal PTH
When to plan BNE?
1- MEN
2- negative or discordant study
3- Intra operative PTH ( IOPTH ) can not be drop

When to covert from MIP to BNE ?


1- diseased gland is not found
2- The ipsilateral PTH looks abnormal
3- IOPTH did not drop 50% at 10 min.
• Type of surgery in SHPT and THP:
1-Subtotal Parathyroidectomy
2- OR Total Parathyroidectomywith Auto Zimplantation

• Post Op Complication
Hypocalcemia ( temporary or permanent)
Recurrent laryngeal nerve RLN injury
Bleeding, hematoma, Seroma
Ectopic Parathyroid Gland

Normal PT
location ?
Ectopic Parathyroid Gland

 Superior 
TE groove, retrosophageal,
parapharyngeal.

 Lower 
Thyro-thymic/thymus, ant.
Mediastinum,
Intrathyroidal
Ectopic Parathyroid Gland
Parathyroid Cancer

o • <1% of PHPT
o Least common endocrine malignancy
o 4th or 5th decade of life
o Same presentation of PHPT

Red flags:
• Palpable neck mass
• Hoarseness
• Calcium > 14 mg/dL, PTH > 300 pg/mL
Parathyroid cancer

o The diagnosis is difficult even histologically


o Invasion to nearby structure raises the suspicion

Rx: en block resection of ipsilateral side


(parathyroidectomy, hemithyroidectomy, ipsilateral
CLND)

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