Minimally invasive parathyroidectomy A conventional parathyroidectomy entails bilateral neck exploration, identification of all four glands, and removal of the grossly enlarged gland(s). The development of accurate preoperative localization studies and a rapid intraoperative parathyroid hormone (ioPTH) assay has fostered the development of minimally invasive approaches to parathyroidectomy. A focused unilateral approach utilizes preoperative imaging to …
What is the best treatment primary hyperparathyroidism but negative preoperative localization studies? Surgery! Patient age < 50 years warrants parathyroidectomy. Remember, failure to localize an abnormal parathyroid on imaging has nothing to do with whether or not a patient has HPT or whether or not the patient should undergo surgery. The sensitivity of preoperative localization studies is …
When should preoperative parathyroid localization studies be performed? An experienced parathyroid surgeon does not require preoperative localization prior to an initial bilateral neck exploration and will have a surgical success rate of > 95%. However, about 85% of patients with primary HPT have a single parathyroid adenoma, and therefore, preoperative imaging is commonly performed. If …
Should subjective symptoms, such as fatigue, irritability, and difficulty concentrating, be considered indications for surgery in primary hyperparathyroidism? Although only a minority of patients with primary HPT manifest the classic symptoms, as many as 90% of patients experience more subtle, subjective symptoms, such as fatigue, weakness, musculoskeletal pains, abdominal discomfort, depression, anxiety, irritability, or memory/cognitive difficulties. In …
Indications for surgery in primary hyperparathyroidism Read More »
Which patients with primary hyperparathyroidism should undergo parathyroidectomy? All patients with primary hyperparathyroidism and “classic” symptoms attributable to the disease (e.g., kidney stones, severe bone disease/fragility fractures, overt neuromuscular syndrome) should undergo surgical intervention; however, most patients do not have these classic symptoms. The National Institutes of Health (NIH) established criteria to assist clinicians in …
Which patients with primary hyperparathyroidism should undergo parathyroidectomy Read More »
When should thyroglossal duct cysts be removed? During the embryologic development of the thyroid, a diverticulum forms from the foramen cecum at the base of the tongue and descends as the thyroglossal duct to the future anatomic position of the thyroid overlying the anterolateral surface of the upper tracheal rings. The thyroglossal duct normally disappears …
What is the appropriate therapy for an intrathoracic (substernal) goiter? Intrathoracic goiters are typically cervical goiters with mediastinal extension. Although commonly asymptomatic, up to 40% of patients present with compressive symptoms resulting from impingement on the esophagus, airway, vascular structures, or nerves. There is general agreement that medical therapy (thyroid hormone suppression and/or radioiodine) is …