title: Patterns of disease in patients at a tertiary referral centre requiring reoperative parathyroidectomy.
abstract: BACKGROUND
  Reoperative parathyroidectomy is required when there is persistent or recurrent hyperparathyroidism following the initial surgery (at least 5% of parathyroidectomies nationally). By convention, 'persistent disease' is defined as the situation where the patient has not been cured by the first operation. The term 'recurrent hyperparathyroidism' is used when the patient was confirmed to be biochemically cured for six months from the first operation but has hyperparathyroidism after this date. Reoperative surgery is associated with higher rates of postoperative complications as well as a greater rate of failure to cure. The aim of our study was to review our departmental experience of reoperative parathyroidectomy, with a view to identify patterns of disease persistence and recurrence.
  
  
  METHODS
  Using a departmental database, patients were identified who had undergone reoperative parathyroidectomy between 2006 and 2014. All the pre, intra and postoperative information was documented including the operative note so as to record the location of the abnormal parathyroid gland found at reoperation.
  
  
  RESULTS
  Almost two-thirds (63%) of patients had negative, equivocal or discordant conventional imaging so secondary investigative tools were required frequently. The majority of abnormal glands were found in eutopic locations. The most common locations for ectopic glands were intrathyroidal, mediastinal and intrathymic. A third (33%) of the patients had multigland disease and over a quarter (28%) had coexisting thyroid disease.
  
  
  CONCLUSIONS
  Persistent hyperparathyroidism represents a challenging patient subgroup for which access to all radiological modalities and intraoperative parathyroid hormone monitoring are required. Patient selection for reintervention is a key determinant in the reoperation cure rate.
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare NHS Trust , UK.
authors.forename: C J
authors.initials: CJ
authors.lastname: McIntyre
authors.affiliation: Imperial College London , UK.
authors.forename: J L Y
authors.initials: JL
authors.lastname: Allen
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare NHS Trust , UK.
authors.forename: V A
authors.initials: VA
authors.lastname: Constantinides
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare NHS Trust , UK.
authors.forename: J E
authors.initials: JE
authors.lastname: Jackson
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare NHS Trust , UK.
authors.forename: N S
authors.initials: NS
authors.lastname: Tolley
authors.affiliation: Hammersmith Hospital, Imperial College Healthcare NHS Trust , UK.|Imperial College London , UK.
authors.forename: F F
authors.initials: FF
authors.lastname: Palazzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000453:epidemiology / Q000601:surgery*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Parathyroid adenoma; Parathyroid disorders; Parathyroid glands; Parathyroidectomy; Primary hyperparathyroidism