Kebebew Electron, Duh Quan-Yang, Clark Orlo H
Department of Surgery, University of California, San Francisco 94143-1674, USA.
Arch Surg. 2004 Sep;139(9):974-7. doi: 10.1001/archsurg.139.9.974.
Patients with tertiary hyperparathyroidism (THPT) commonly have parathyroid hyperplasia and should have a bilateral neck exploration with subtotal or total parathyroidectomy with autotransplantation to obtain long-term cure.
A retrospective cohort study.
Tertiary referral medical center.
Thirty-four consecutive patients (21 women and 13 men; mean age, 48 years) who underwent neck exploration for THPT.
Sites and histologic pattern of parathyroid disease, and postoperative normalization of serum calcium and parathyroid hormone levels.
Twenty-seven patients underwent initial bilateral neck exploration and 7 patients underwent repeat neck exploration for persistent or recurrent THPT. The mean serum total calcium level was 11.2 mg/dL (2.8 mmol/L) (range, 10.3-13.5 mg/dL [2.6-3.4 mmol/L]) and the mean intact parathyroid hormone level was 355 ng/L (range, 95-1236 ng/L). The THPT was due to 4-gland hyperplasia in 33 patients and a single adenoma in only 1 patient. The parathyroid glands were in the normal position in 23 patients and in ectopic locations in 11 patients (8 intrathymic, 1 carotid sheath, 1 tracheoesophageal groove, and 1 intramuscular). Preoperative localizing studies did not identify ectopic or supernumerary glands in any of the patients (ultrasonography, 14 patients; technetium Tc 99m sestamibi, 15; and magnetic resonance imaging, 7). Persistent (n = 5) and recurrent (n = 2) THPT was more common in patients who had an initial 1- or 2-gland excision instead of subtotal or total parathyroidectomy with autotransplantation (P<.001). Four patients had transient hypocalcemia (<8.0 mg/dL [<2.0 mmol/L]), and no other permanent complications or deaths occurred. Biochemical cure was achieved in 94% of patients with a mean follow-up of 4.8 years.
Tertiary hyperparathyroidism is usually due to multiple hyperplastic parathyroid glands, and patients who have initial limited parathyroidectomy have a higher risk of persistent or recurrent THPT.
三发性甲状旁腺功能亢进症（THPT）患者通常存在甲状旁腺增生，应进行双侧颈部探查，并实施甲状旁腺次全切除术或全切除术及自体移植，以实现长期治愈。
一项回顾性队列研究。
三级转诊医疗中心。
连续34例因THPT接受颈部探查的患者（21例女性和13例男性；平均年龄48岁）。
甲状旁腺疾病的部位和组织学模式，以及术后血清钙和甲状旁腺激素水平恢复正常情况。
27例患者接受了初次双侧颈部探查，7例患者因持续性或复发性THPT接受了再次颈部探查。血清总钙平均水平为11.2mg/dL（2.8mmol/L）（范围为10.3 - 13.5mg/dL[2.6 - 3.4mmol/L]），完整甲状旁腺激素平均水平为355ng/L（范围为95 - 1236ng/L）。33例患者的THPT是由4个腺体增生引起的，只有1例患者是由单个腺瘤引起的。23例患者的甲状旁腺位于正常位置，11例患者的甲状旁腺位于异位（8例位于胸腺内，1例位于颈动脉鞘，1例位于气管食管沟，1例位于肌肉内）。术前定位检查未在任何患者中发现异位或多余的腺体（超声检查14例患者；锝Tc 99m甲氧基异丁基异腈检查15例；磁共振成像检查7例）。初次进行1个或2个腺体切除而非甲状旁腺次全切除术或全切除术及自体移植的患者中，持续性（n = 5）和复发性（n = 2）THPT更为常见（P<0.001）。4例患者出现短暂性低钙血症（<8.0mg/dL [<2.0mmol/L]），未发生其他永久性并发症或死亡。平均随访4.8年，94%的患者实现了生化治愈。
三发性甲状旁腺功能亢进症通常是由多个增生的甲状旁腺腺体引起的，初次进行有限甲状旁腺切除术的患者发生持续性或复发性THPT的风险更高。
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