title: Intrathyroid adenomas in primary hyperparathyroidism: are they frequent enough to guide surgical strategy?
abstract: BACKGROUND
  Ectopic parathyroid adenoma, including intrathyroid adenoma, is a common cause of failed parathyroid operations. The aim of this study was to evaluate the operative strategy/outcome in patients with primary hyperparathyroidism (pHPT), with special regard to intrathyroid adenomas.
  
  
  METHODS
  The authors performed an analysis of all patients receiving operative treatment for pHPT from 2003 through 2005. The operative strategy consisted of systematic perithyroid exploration followed by extended cervical exploration in cases where the adenoma was not found initially. In cases of persistent, high intraoperative parathyroid hormone levels, hemithyroidectomy was performed on the side with higher suspicion of intrathyroid adenoma or with more extended thyroid changes.
  
  
  RESULTS
  During the study, 115 patients received surgical treatment for sporadic pHPT. A single parathyroid adenoma (normal parathyroid position) was found in 95 patients (82.6%), ectopic single adenoma was found in 7 patients (6.1%), and double adenomas were found in 10 (8.7%) patients. Operative failure occurred in 3 cases (2.6%). In all, 4 of 7 ectopic single adenomas were intrathyroidal and were removed by hemithyroidectomy according to the authors' standard protocol.
  
  
  CONCLUSIONS
  The strategy of (a) cervical exploration, (b) extended cervical exploration, and (c) hemithyroidectomy was highly successful for removing undetectable intrathyroid parathyroid adenomas during primary intervention, thereby reducing the risks associated with reintervention.
authors.affiliation: University Hospital of Bern, Bern, Switzerland.
authors.forename: Uta
authors.initials: U
authors.lastname: Herden
authors.forename: Christian A
authors.initials: CA
authors.lastname: Seiler
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
authors.forename: Stefan W
authors.initials: SW
authors.lastname: Schmid
mesh_terms: D000236:Adenoma / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D003949:Diagnostic Techniques, Surgical; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery*; D016105:Parathyroidectomy; D018579:Patient Selection; D012189:Retrospective Studies; D013965:Thyroidectomy; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone