title: Surgical treatment of hyperparathyroidism in patients with multiple endocrine neoplasia type 1.
abstract: OBJECTIVE
  Three-gland parathyroidectomy with trans-cervical thymectomy and cryopreservation is the preferred initial surgical approach for hyperparathyroidism (HPT) in patients with multiple endocrine neoplasia type 1.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Thirty-seven patients with multiple endocrine neoplasia type 1 who underwent 1 or more surgical procedures for HPT from January 1, 1973 to April 30, 2004.
  
  
  RESULTS
  At initial parathyroid surgery, 16 (43%) of 37 patients had fewer than 3 parathyroid glands resected (group 1); 16 (43%) had at least 3 but fewer than 4 glands (group 2), and 5 (14%), 4 or more glands (group 3). Follow-up of at least 6 months after initial surgery was complete for 31 (84%) of 37 patients.
  
  
  CONCLUSIONS
  Recurrent HPT in patients with multiple endocrine neoplasia type 1 is frequent if fewer than 3 glands are removed at initial parathyroidectomy. Optimal surgical intervention must balance the risk of recurrent hypercalcemia with the morbidity of permanent hypoparathyroidism. Three-gland parathyroidectomy, transcervical thymectomy, and parathyroid cryopreservation constitute our preferred initial surgical procedure.
authors.affiliation: Department of Surgical Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, 77230-1402, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Lambert
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Shapiro
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Perrier
authors.forename: Mylene
authors.initials: M
authors.lastname: Truong
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wallace
authors.forename: Ana O
authors.initials: AO
authors.lastname: Hoff
authors.forename: Robert F
authors.initials: RF
authors.lastname: Gagel
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications*; D016105:Parathyroidectomy; D012189:Retrospective Studies; D016896:Treatment Outcome