title: Unilateral Clearance for Primary Hyperparathyroidism in Selected Patients with Multiple Endocrine Neoplasia Type 1.
abstract: Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism.
  
  
  
  We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism.
  
  
  
  Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54).
  
  
  
  Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations.
authors.affiliation: Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, San Francisco, CA, 94115, USA. wpkluijfhout@gmail.com.|Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. wpkluijfhout@gmail.com.
authors.forename: Wouter P
authors.initials: WP
authors.lastname: Kluijfhout
authors.affiliation: Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, San Francisco, CA, 94115, USA.
authors.forename: Toni
authors.initials: T
authors.lastname: Beninato
authors.affiliation: Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, San Francisco, CA, 94115, USA.
authors.forename: Frederick Thurston
authors.initials: FT
authors.lastname: Drake
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Menno R
authors.initials: MR
authors.lastname: Vriens
authors.affiliation: Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, San Francisco, CA, 94115, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gosnell
authors.affiliation: Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, San Francisco, CA, 94115, USA.
authors.forename: Wen T
authors.initials: WT
authors.lastname: Shen
authors.affiliation: Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, San Francisco, CA, 94115, USA.
authors.forename: Insoo
authors.initials: I
authors.lastname: Suh
authors.affiliation: Division of Endocrinology, University of California, San Francisco, CA, USA.
authors.forename: Chienying
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Surgery, University of California, Mt Zion, 1600 Divisadero Street, San Francisco, CA, 94115, USA.
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D007011:Hypoparathyroidism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D018579:Patient Selection; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D013934:Thymectomy; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi