title: Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center.
abstract: Most cases of sporadic primary hyperparathyroidism present disturbances in a single parathyroid gland and the surgery of choice is adenomectomy. Conversely, hyperparathyroidism associated with multiple endocrine neoplasia type 1 (hyperparathyroidism/multiple endocrine neoplasia type 1) is an asynchronic, asymmetrical multiglandular disease and it is surgically approached by either subtotal parathyroidectomy or total parathyroidectomy followed by parathyroid auto-implant to the forearm. In skilful hands, the efficacy of both approaches is similar and both should be complemented by prophylactic thymectomy. In a single academic center, 83 cases of hyperparathyroidism/ multiple endocrine neoplasia type 1 were operated on from 1987 to 2010 and our first surgical choice was total parathyroidectomy followed by parathyroid auto-implant to the non-dominant forearm and, since 1997, associated transcervical thymectomy to prevent thymic carcinoid. Overall, 40% of patients were given calcium replacement (mean intake 1.6 g/day) during the first months after surgery, and this fell to 28% in patients with longer follow-up. These findings indicate that several months may be needed in order to achieve a proper secretion by the parathyroid auto-implant. Hyperparathyroidism recurrence was observed in up to 15% of cases several years after the initial surgery. Thus, long-term follow-up is recommended for such cases. We conclude that, despite a tendency to subtotal parathyroidectomy worldwide, total parathyroidectomy followed by parathyroid auto-implant is a valid surgical option to treat hyperparathyroidism/multiple endocrine neoplasia type 1. Larger comparative systematic studies are needed to define the best surgical approach to hyperparathyroidism/multiple endocrine neoplasia type 1.
authors.affiliation: Department of Surgery, Head and Neck Surgery Section, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. fabiomonte@uol.com.br
authors.forename: Fabio Luiz de Menezes
authors.initials: FL
authors.lastname: Montenegro
authors.forename: Delmar Muniz
authors.initials: DM
authors.lastname: Lourenço
authors.forename: Marcos Roberto
authors.initials: MR
authors.lastname: Tavares
authors.forename: Sergio Samir
authors.initials: SS
authors.lastname: Arap
authors.forename: Climerio Pereira
authors.initials: CP
authors.lastname: Nascimento
authors.forename: Ledo Mazzei
authors.initials: LM
authors.lastname: Massoni Neto
authors.forename: André
authors.initials: A
authors.lastname: D'Alessandro
authors.forename: Rodrigo Almeida
authors.initials: RA
authors.lastname: Toledo
authors.forename: Flávia Lima
authors.initials: FL
authors.lastname: Coutinho
authors.forename: Lenine Garcia
authors.initials: LG
authors.lastname: Brandão
authors.forename: Gilberto
authors.initials: G
authors.lastname: de Britto e Silva Filho
authors.forename: Anói Castro
authors.initials: AC
authors.lastname: Cordeiro
authors.forename: Sergio Pereira Almeida
authors.initials: SP
authors.lastname: Toledo
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology / Q000601:surgery*; D008297:Male; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications / Q000601:surgery*; D010280:Parathyroid Glands / Q000637:transplantation; D010282:Parathyroid Neoplasms / Q000150:complications / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D014182:Transplantation, Autologous