Total parathyroidectomy in a large cohort of cases with hyperparathyroidism associated with multiple endocrine neoplasia type 1: experience from a single academic center

• Main Authors: Fabio Luiz de Menezes Montenegro, Delmar Muniz Lourenço Junior, Marcos Roberto Tavares, Sergio Samir Arap, Climerio Pereira Nascimento Junior, Ledo Mazzei Massoni Neto, André D'Alessandro, Rodrigo Almeida Toledo, Flávia Lima Coutinho, Lenine Garcia Brandão, Gilberto de Britto e Silva Filho, Anói Castro Cordeiro, Sergio Pereira Almeida Toledo
• Format: Article
• Language: English
• Published: Faculdade de Medicina / USP 2012-01-01
• Series: Clinics
• Subjects: Hyperparathyroidism; Parathyroidectomy; MEN1; Parathyroid glands; Parathyroid neoplasms; Hypercalcemia
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322012001300022
• ISSN: 1807-5932; 1980-5322

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.