Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Surgery. 2013 May;153(5):718-22. doi: 10.1016/j.surg.2012.11.025. Epub 2013 Jan 22.
Lithium-associated hyperparathyroidism has been attributed to multigland hyperplasia requiring bilateral exploration and subtotal parathyroidectomy. Recent studies suggest that some patients may have single gland disease and be eligible for minimally invasive parathyroidectomy.
We performed a retrospective review of a prospective, single institution parathyroid database of 1,010 patients who underwent parathyroidectomy between December 1999 and October 2010.
Nineteen patients with a history of lithium therapy and sporadic hyperparathyroidism were identified. Median age was 50 years (16-68); median duration of therapy was 19 years (1-37); 11 (58%) were on active therapy with lithium for multiple reasons. Preoperative median serum calcium was 10.9 mg/dL (10.0-12.3), median parathyroid hormone was 111 pg/mL (60-186). A total of 18 patients underwent preoperative imaging. Of 12 patients with single-site localization, 6 (50%) underwent a minimally invasive parathyroidectomy, 2 (17%) underwent unilateral explorations, 1 (8%) underwent bilateral exploration, and 3 (25%) had concomitant thyroidectomies. Six patients did not localize and underwent bilateral exploration for multigland disease. One patient without preoperative imaging had single-gland disease. In all operations surgeons used intraoperative parathyroid hormone (IOPTH) monitoring and met intraoperative criteria. Median IOPTH decrease was 74% (54-86) in single-gland disease and 85% (76-95) in multigland disease. Median abnormal gland weight was 590 mg (134-6,750) in single-gland disease and 296 mg (145-2,170) in multigland disease. All patients were normocalcemic at a median follow-up of 19 months (2-118).
Of 19 patients with lithium exposure, 6 (32%) had multigland disease. However, of the 13 (68%) patients with single gland disease, all 12 who had preoperative imaging had single-site localization. If localization suggests single gland disease, minimally invasive parathyroidectomy with IOPTH monitoring can be successfully performed.
锂相关甲状旁腺功能亢进症归因于多腺体增生，需要进行双侧探查和甲状旁腺次全切除术。最近的研究表明，一些患者可能患有单腺体疾病，有资格进行微创甲状旁腺切除术。
我们对 1999 年 12 月至 2010 年 10 月期间在一家机构进行甲状旁腺切除术的 1010 例患者的前瞻性单机构甲状旁腺数据库进行了回顾性分析。
确定了 19 例有锂治疗史和散发性甲状旁腺功能亢进症的患者。中位年龄为 50 岁（16-68 岁）；中位治疗时间为 19 年（1-37 年）；11 例（58%）因多种原因正在服用活性锂治疗。术前中位血清钙为 10.9mg/dL（10.0-12.3），中位甲状旁腺激素为 111pg/mL（60-186）。18 例患者进行了术前影像学检查。在 12 例单部位定位的患者中，6 例（50%）行微创甲状旁腺切除术，2 例（17%）行单侧探查，1 例（8%）行双侧探查，3 例（25%）行甲状腺切除术。6 例未定位，双侧探查为多腺体疾病。1 例无术前影像学检查的患者为单腺体疾病。在所有手术中，外科医生均使用术中甲状旁腺激素（IOPTH）监测，并符合术中标准。单腺体疾病的 IOPTH 下降中位数为 74%（54-86），多腺体疾病为 85%（76-95）。单腺体疾病中异常腺体重量中位数为 590mg（134-6750），多腺体疾病中为 296mg（145-2170）。所有患者在中位随访 19 个月（2-118 个月）时血钙正常。
在 19 例锂暴露患者中，6 例（32%）有多腺体疾病。然而，在 13 例（68%）单腺体疾病患者中，所有 12 例有术前影像学检查的患者均有单部位定位。如果定位提示单腺体疾病，则可成功进行 IOPTH 监测的微创甲状旁腺切除术。
