Multiglandular parathyroid disease
- A single adenoma is, by far, the most common cause of primary HPT (85%). Depending on the method used to define multiglandular disease (i.e., ioPTH assay versus gross appearance/size), the reported rates range from 5% to 35%.
- Multiglandular disease can be caused by either multiple adenomas or four-gland hyperplasia.
- Hyperplasia may be sporadic or secondary to a genetic predisposition, such as MEN syndrome.
- When all four glands are hyperplastic, a subtotal parathyroidectomy is required (removal of 3½ glands).
- It is important that the surgeon be careful to preserve the blood supply to the parathyroid remnant.
- If after removing half the final parathyroid the remnant appears ischemic, then it should be excised and autotransplanted, either to the brachioradialis muscle in the nondominant forearm or the sternocleidomastoid muscle.
- Most patients (95%) will have normal calcium and low or normal parathyroid hormone levels; however, permanent hypoparathyroidism occurs in 2% to 3% and recurrent hyperparathyroidism occurs in about 10% of patients.
