title: Location Frequency of Missed Parathyroid Glands After Parathyroidectomy in Patients with Persistent or Recurrent Secondary Hyperparathyroidism.
abstract: BACKGROUND
  Reoperative parathyroidectomy (RPTX) because parathyroid glands have been missed is frequently required in patients with secondary hyperparathyroidism (SHPT). The usual locations of these missed glands in patients with SHPT are yet to be fully elucidated.
  
  
  METHODS
  We retrospectively investigated the locations of missed glands in 165 patients who underwent RPTX for persistent or recurrent SHPT at our institution from August 1982 to July 2014. At our institution, total parathyroidectomy with forearm autograft is the routine operative procedure for SHPT. We also routinely resect the thymic tongue.
  
  
  RESULTS
  Of 165 patients, 82 underwent initial parathyroidectomy at our institution (Group A), and the remaining 83 underwent initial parathyroidectomy at other institutions (Group B). A total of 239 parathyroid glands were resected (Group A, 93; Group B, 146). Missed glands were most commonly located in the mediastinum (Group A, 22/93) and the thymic tongue (Group B, 31/146).
  
  
  CONCLUSIONS
  In patients with persistent or recurrent SHPT, ectopic parathyroid glands are frequently located in the mediastinum and thymic tongue. Therefore, resecting the thymic tongue during the initial operation may reduce the need for RPTX.
authors.affiliation: Department of Transplantation and Endocrine Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan. ubanamadako@yahoo.co.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Okada
authors.affiliation: Department of Transplantation and Endocrine Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tominaga
authors.affiliation: Department of Transplantation and Endocrine Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Transplantation and Endocrine Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
authors.forename: Takahisa
authors.initials: T
authors.lastname: Hiramitsu
authors.affiliation: Department of Transplantation and Endocrine Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Narumi
authors.affiliation: Department of Transplantation and Endocrine Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Watarai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D010280:Parathyroid Glands / Q000637:transplantation*; D016105:Parathyroidectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D014182:Transplantation, Autologous