title: Recurrent hyperparathyroidism and forearm parathyromatosis after total parathyroidectomy.
abstract: BACKGROUND
  In multiple endocrine neoplasia type I and renal failure, the type of initial parathyroidectomy for hyperparathyroidism may influence the operative risks and development of recurrence. We compared subtotal parathyroidectomy with total parathyroidectomy and immediate forearm autotransplantation (TPFA) in a large series with long-term follow-up.
  
  
  METHODS
  The data of patients treated from 1977 to 2009 by initial or reoperative TPFA or subtotal parathyroidectomy were examined for outcomes including the interval to sites and tissue patterns of recurrence.
  
  
  RESULTS
  Permanent hypoparathyroidism was rare and uninfluenced by disease type. Neither initial procedure nor underlying disease affected the mean time to reoperation for recurrent hyperparathyroidism. In renal failure, reoperation was more common after TPFA than subtotal parathyroidectomy (5/19, 26% vs 11/193, 6%; P = .008). Twelve patients required forearm reoperation after TPFA, which was often complicated by parathyromatosis (7/12, 58%). Further reoperative forearm surgery was more likely after explant excision than after en bloc resection (7/11 vs 0/8; P = .01) and occurred sooner in renal failure than in multiple endocrine neoplasia type I (mean 4.4 vs 9 years; P = .04). Permanent hypoparathyroidism was rare and uninfluenced by disease type.
  
  
  CONCLUSIONS
  Because of frequent recurrence, TPFA should be abandoned as a treatment of renal hyperparathyroidism. In multiple endocrine neoplasia type I, subtotal parathyroidectomy has similar outcomes to TPFA. Forearm autotransplantation can be complicated by parathyromatosis, and surgeons should be prepared for reoperative en bloc resection.
authors.affiliation: Section of Endocrine Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Adrienne L
authors.initials: AL
authors.lastname: Melck
authors.forename: Sally E
authors.initials: SE
authors.lastname: Carty
authors.forename: Raja R
authors.initials: RR
authors.lastname: Seethala
authors.forename: Michaele J
authors.initials: MJ
authors.lastname: Armstrong
authors.forename: Michael T
authors.initials: MT
authors.lastname: Stang
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Ogilvie
authors.forename: Linwah
authors.initials: L
authors.lastname: Yip
mesh_terms: D016208:Databases, Factual; D005260:Female; D005542:Forearm; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000601:surgery*; D010280:Parathyroid Glands / Q000637:transplantation*; D016105:Parathyroidectomy; D012008:Recurrence; D051437:Renal Insufficiency / Q000150:complications*; D012086:Reoperation; D014182:Transplantation, Autologous