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At least 289 records · Page 16Linked to original sources
PubMed1999

Preoperative imaging of parathyroid glands with technetium-99m-labelled sestamibi and iodine-123 subtraction scanning in secondary hyperparathyroidism.

BACKGROUND: Parathyroidectomy is unsuccessful in 10-30% of uraemic patients operated on for secondary hyperparathyroidism. We investigated the usefulness of preoperative radionuclide imaging, with simultaneous recording of the distribution images of iodine-123 and technetium-99m-labelled sestamibi. METHODS: 11 patients with secondary hyperparathyroidism underwent prospective imaging and parathyroidectomy. Plasma concentrations of intact parathyroid hormone (PTH) were measured in all patients before and 6 months after subtotal parathyroidectomy. FINDINGS: Preoperative scanning showed 42 hot-spots suggesting enlarged parathyroid glands. 45 glands were discovered at surgery, and the parathyroidectomy was deemed successful in ten patients. Among the latter, one patient had a supernumerary parathyroid gland detected by scanning and resected from the left thymus. Another patient showed ectopic uptake corresponding to a large parathyroid gland in the upper mediastinum, and another had a parathyroid gland well above the thyroid. No false-positive scan findings were documented. In the patient for whom parathyroidectomy failed, preoperative scanning suggested five enlarged parathyroid glands, though the surgeon found only four glands, in their normal positions. Hyperparathyroidism persisted (intact PTH 527 ng/L, 6 months after surgery). A second scan confirmed the preoperative scan, showing a fifth parathyroid gland in the middle of the right thyroid lobe. INTERPRETATION: Simultaneous recording of 99mTc-sestamibi and 123I improved the imaging of parathyroid glands in secondary hyperparathyroidism. The technique can identify ectopic and supernumerary parathyroid glands.

Adult↗
PubMed2006

[In situ preservation of parathyroid glands in total or near total thyroidectomy].

OBJECTIVE: To investigate the preservation of parathyroid glands and its function during total or near-total thyroidectomy. METHOD: One hundred and thirty one patients underwent total thyroidectomy, near total thyroidectomy, hemithyroidectomy and isthmectomy. In operation, the parathyroid glands were exposed, or were identified under microscope when necessary. The third rank of inferior thyroid arteries was ligated to preserve parathyroid glands in situ, and the parathyroid function was observed after thyroidectomy. RESULT: Four patients (3%) had a transient hypoparathyroidism after thyroidectomy, 26 patients (20%) had a obviously biochemical hypocalcemia with no symptoms, 73 patients (56%) had a lower calcium level in the first 3 days after surgery compared with preoperative level, 28 (21%) patients who underwent ipsilateral total and contralateral subtotal isthmectomy were all normocalcemic after surgery. There were no permanent hypoparathyroidism and death in our study population. CONCLUSION: In total or near-total thyroidectomy, parathyroid glands and its artery blood-supply should be exposed and preserved. Vasodilator and calcium supplementation should be given to patients with obviously lower serum calcium level after surgery to prevent permanent hypoparathyroidism.

Adolescent↗
PubMed1995

Growth of parathyroid gland in uremic patients on maintenance hemodialysis.

High-resolution, real-time ultrasonography was performed in 245 uremic patients on maintenance hemodialysis and the growth of the enlarged parathyroid glands was compared with the clinical and biochemical signs during follow-up periods of 12 months. The total volume of the parathyroid glands was significantly correlated with the serum C-terminal parathyroid hormone (C-PTH; r = 0.379, p = 0.0001) and calcium levels (r = 0.252, p = 0.0224). After 12 months, the total volume of the enlarged parathyroid glands and serum C-PTH or calcium levels were correlated more closely than in the initial study (r = 0.615, p = 0.0001, and r = 0.489, p = 0.0002, respectively). Both the serum C-PTH levels and the total volume of the enlarged parathyroid glands increased significantly (p = 0.0001), while the ratio between the serum C-PTH levels and the volume of the parathyroid glands decreased significantly (p = 0.0001). There was no difference in the clinical and biochemical signs except for the serum aluminum levels between the patients with and without an increased gland volume. These results suggest that the growth of parathyroid glands may progress more rapidly than the increase in the serum PTH levels, independent of the serum calcium levels, in uremic patients on maintenance hemodialysis.

Adolescent↗
PubMed1998

Autotransplantation of parathyroid glands into subcutaneous forearm tissue for renal hyperparathyroidism.

BACKGROUND: Autotransplantation of diseased parathyroid glands into subcutaneous adipose tissue has been mentioned previously, but as far as we know there is no previous systemic study concerning parathyroid function after subcutaneous autotransplantation. METHODS: From January 1993 to June 1996, total parathyroidectomy and autotransplantation were carried out in 46 patients with renal hyperparathyroidism. The symptoms and signs before operation were intractable pruritus in 29 patients (63%), bone pain in 27 patients (58.7%), general weakness in 17 patients (37%), soft tissue calcification in 15 patients (32.6%), bone fracture in one patient, and failure to thrive in one patient. Twenty-four patients (group A) underwent autotransplantation of 60 mg of a diffuse hyperplastic parathyroid gland into subcutaneous forearm tissue, and 22 patients (group B) underwent autotransplantation of 15 pieces (60 mg) of 1 mm3 tissue into forearm muscles, as mentioned previously. Four patients in group A and one in group B who had high levels of intact parathyroid hormone (I-PTH) immediately after operation were excluded. After the operation, calcium carbonate, 1.5 to 16 gm daily, and calcitriol, 0.25 to 1.5 micrograms/daily, were prescribed according to the patients' calcium levels. RESULTS: After 6 months, all patients in both groups were given calcium carbonate, 1 gm/day, and calcitriol, 0.25 microgram/day, for parathyroid suppression, and none had to take more medicine to maintain calcium levels. There were no significant differences between the two groups regarding serum calcium, phosphorous, alkaline phosphatase, and I-PTH levels 1 week, 3 to 6 months, and 1 year after operation. Eighteen patients in group A and 19 patients in group B had normal levels of I-PTH 1 year after operation. In the follow-up period from 1 to 3 1/2 years, only one patient in group A had a subnormal I-PTH level and one in group B had graft-dependent hyperparathyroidism. CONCLUSIONS: We therefore suggest that autotransplantation of a parathyroid gland into forearm subcutaneous tissue for renal hyperparathyroidism is as effective as autotransplantation into forearm muscles and can be done easier.

Adolescent↗
PubMed1988

Parathyroid gland hemorrhage in perinatally lethal osteogenesis imperfecta.

In four neonates with perinatally lethal osteogenesis imperfecta (OI) who survived for more than 9 days after birth, vascular congestion and acute hemorrhage were found in 10 of 11 parathyroid glands; in one neonate, all four parathyroid glands, including the only gland without acute hemorrhage, contained abundant deposits of stainable iron. One neonate had hypocalcemia, and one had both hyperphosphatemia and hypocalcemia. In four neonates with OI who died within 72 minutes of birth, all 10 parathyroid glands demonstrated were free of hemorrhage and hemosiderin deposition. Only minor foci of acute hemorrhage were seen in three of 170 glands in 113 comparison neonates and infants. We conclude that parathyroid gland hemorrhage is common in perinatally lethal OI with survival beyond the immediate period of birth, and is otherwise rare. We speculate that parathyroid hemorrhage may be related to difficulty in maintaining postnatal calcium homeostasis in the absence of adequate calcium reserves in bone. Acute parathyroid gland hemorrhage causes fluctuations in serum calcium levels that have on occasion proved fatal, and parathyroid hemorrhage may be a proximate cause of death in some neonates with OI.

Female↗
PubMed2003

Guidelines for percutaneous ethanol injection therapy of the parathyroid glands in chronic dialysis patients.

Percutaneous ethanol injection therapy (PEIT) of the parathyroid was originally introduced as an alternative to surgical parathyroidectomy. After the recent elucidation of the pathogenesis of parathyroid hyperplasia in uraemia, 'selective PEIT of the parathyroid glands' was developed, in which enlarged parathyroid glands with nodular hyperplasia are 'selectively' destroyed by ethanol injection, and other glands with diffuse hyperplasia are then managed by medical therapy. The 'Guidelines for percutaneous ethanol injection therapy of the parathyroid glands in chronic dialysis patients' proposed by the Japanese Society for Parathyroid Intervention are presented, including indications, techniques, and post-PEIT management. These guidelines also apply to direct injection therapy using drugs other than ethanol, such as calcitriol and 22-oxacalcitriol.

Ethanol↗
PubMed1995

[Detection and localization of enlarged parathyroid glands in patients with hyperparathyroidism using 99mTc-methoxyisobutylisonitrile (MIBI): a study of subtraction scintigraphy with 99mTc-pertechnetate].

In this study we investigated the detectability of abnormal parathyroid gland(s) by 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy in patients with hyperparathyroidism. The subjects were 6 patients with primary hyperparathyroidism (PHP) with a single adenoma and 13 patients with renal hyperparathyroidism (RHP) on chronic maintenance hemodialysis. The imaging data of 99mTc-pertechnetate were subtracted from those of 99mTc-MIBI (MIBI-Tc), and number and location of the positive images on scintigrams were compared with those obtained by conventional scintigraphy using 201Tl-Cl and 99mTc-pertechnetate (Tl-Tc). All of the patients underwent surgery, and the number and location of the abnormal parathyroid glands were confirmed. The number of resected parathyroid glands were 6 in PHP and 52 in RHP. The detectability of MIBI-Tc was 83.3% in PHP and 51.9% in RHP, while that of Tl-Tc was 100% and 44.2%, respectively. Although no statistically significant difference in the detectability was found between MIBI-Tc and Tl-Tc, the number of false positives with MIBI-Tc was less than that with Tl-Tc. The detectability of MIBI-Tc depended on the size of the parathyroid gland. The maximal diameter and weight of the smallest parathyroid gland detected were 15 mm and 290 mg in PHP, and 9 mm and 50 mg in RHP. The existence of the thyroid gland did not reduce the detectability of MIBI-Tc. In conclusion, MIBI-Tc was clinically very useful for the detection of abnormal parathyroid glands in patients with hyperparathyroidism.

Adult↗
PubMed2002

Underexpression of Gcm2, a master regulatory gene of parathyroid gland development, in adenomas of primary hyperparathyroidism.

OBJECTIVE: Glial cells missing (Gcm) was first identified as a binary switch between neuronal and glial determination in Drosophila. Two homologues of Drosophila Gcm have been identified in mice and humans, namely Gcm1 and Gcm2. Mouse Gcm2 is restricted to parathyroid tissues and Gcm2 was recently identified as a master regulatory gene of parathyroid gland development as Gcm2 knockout mice lack parathyroid glands. DESIGN/PATIENTS: To identify Gcm2 transcripts in human non-neural tissues and to examine whether Gcm2 is involved in parathyroid gland tumorigenesis we analysed Gcm2 transcript levels in several non-neural tissues by reverse transcriptase polymerase chain reaction (RT-PCR) and performed real-time quantitative RT-PCR analysis on five normal glands, 15 parathyroid adenomas of primary hyperparathyroidism (HPT) and nine hyperplastic glands of secondary HPT. RESULTS: We found high Gcm2 mRNA expression in human parathyroid glands in comparison with other non-neural tissues and underexpression in parathyroid adenomas but not in lesions of HPT secondary to uraemia. CONCLUSION: Because adenomas demonstrate lower Gcm2 expression than normal glands we suggest that reduced expression of Gcm2 contributes to parathyroid gland tumorigenesis. We speculate that a proper expression level of the Gcm2 transcription factor could be important for maintaining a fully differentiated state of the parathyroid cell.

Adenoma↗
PubMed1982

Primary hyperparathyroidism due to overactive intrathyroid parathyroid glands: a potential cause of failed exploration.

The variable location of the parathyroid glands is a significant factor in unsuccessful cervical exploration for hyperparathyroidism. Particular difficulty may be experienced when an overactive parathyroid is concealed within the substance of the thyroid. Currently available methods of localizing abnormal parathyroid tissue may well fail to indicate an intrathyroid location. The latter possibility should always be considered whenever thorough cervical exploration has failed to reveal a parathyroid tumour as such awareness may obviate re-exploration or an unnecessary sternotomy. This report details the clinical features and operative findings in 6 patients whose primary hyperparathyroidism was due to an overactive intrathyroid parathyroid gland. Successful parathyroid surgery demands a strict routine exploration of the possible sites of overactive glands, virtually all of which are easily accessible through a standard collar incision.

Adenoma↗
PubMed1998

Identification of pathologic parathyroid glands in patients with primary hyperparathyroidism.

Localization of the parathyroid glands is not necessarily easy before surgery and can also be troublesome during surgery. This study focuses on the identification of pathologic parathyroid glands. The records of 32 patients who underwent parathyroidectomy at our institution in the past 14 years for primary hyperparathyroidism were reviewed. Twenty-three patients had a single lesion while 9 had multiple-gland involvement. Localization studies identified 17 of 23 patients with a single lesion. All patients with multiple lesions were diagnosed with an enlargement of the parathyroids, but not all glands were identified in each patient preoperatively. At surgery, 8 of 32 patients were explored unilaterally. Solitary enlarged glands were resected, and a subtotal parathyroidectomy was performed for multiple-gland involvement. The intraoperative serum intact parathyroid hormone (PTH) level dropped after resection of the largest gland. The serum PTH level correlated with the gland size (r = 0.861, intact PTH assay). Eight of 9 patients with multiple-gland involvement had an elevated serum PTH (>2000 pg/ml in midportion and >200 pg/ml in intact PTH assays, respectively). No patient developed persistent or recurrent hyperparathyroidism. The serum PTH level was normalized by a resection of relatively enlarged glands in our cases. It is usual to explore all glands during surgery, and in cases with a high serum PTH level, multiple-gland involvement should also be considered.

Adult↗
PubMed1989

The intrathyroidal hyperfunctioning parathyroid gland.

Six cases of primary hyperparathyroidism due to hyperfunctioning intrathyroidal parathyroid glands are reported. In five cases, hyperparathyroidism was due to an intrathyroidal parathyroid adenoma; in the sixth case, hyperparathyroidism resulted from an intrathyroidal parathyroid carcinoma. All five patients with adenoma were female with ages ranging from 40 to 70 yr. The patient with carcinoma was a 55-yr-old male. In all five patients with intrathyroidal parathyroid adenoma, thyroidectomy was performed when an abnormal parathyroid gland could not be located in the neck during surgery for hyperparathyroidism. The patient with intrathyroidal parathyroid carcinoma presented with hypercalcemia and a palpable right thyroid mass. The differential diagnosis of intrathyroidal parathyroid adenoma includes thyroid follicular adenoma. In some cases, the possibility of medullary carcinoma of thyroid might also be considered. Immunocytochemical staining for parathormone (PTH), thyroglobulin, and calcitonin is valuable in establishing the correct diagnosis.

Adenoma↗
PubMed1980

Surgery of the parathyroid glands.

Surgical procedures involving the parathyroid glands pose special problems. Careful attention to preoperative rehydration, control of hypercalcemia, and evaluation of renal function are mandatory. Intraoperative management is usually uncomplicated. Severe hypocalcemia may complicate the postoperative period, especially if severe bone disease is present.

Adult↗
PubMed2000

Presence of sonographically detectable parathyroid glands can predict resistance to oral pulsed-dose calcitriol treatment of secondary hyperparathyroidism.

Oral pulsed-dose calcitriol administration has been shown to be effective therapy for patients with secondary hyperparathyroidism. However, this effect is not consistently observed in the clinical setting. This study was undertaken to examine whether enlarged parathyroid glands can serve as a clinical marker that predicts the suppressive effect of calcitriol. Thirty-five patients undergoing chronic hemodialysis (HD) were examined (age, 51.9 +/- 14.9 years; duration of HD, 72.0 +/- 56.0 months). Based on the volume of parathyroid glands measured using an ultrasonographic scanner, patients were divided into two groups: 15 patients with undetectable parathyroid glands (ND group) and 20 patients with detectable parathyroid glands (D group; mean volume of parathyroid glands, 261. 9 +/- 347.5 mm(3)). No significant differences were found in serum ionized calcium (Ca(++)) or parathyroid hormone (PTH) levels before calcitriol administration between the two groups. For each patient, 8 microg of calcitriol was administered orally at the end of the HD session, and the changes in serum PTH levels were determined 44 hours after dosing. No significant differences were found between the two groups in serum Ca(++) levels. However, a significant decrease in serum PTH levels was observed in the ND group, whereas no significant changes were found in the D group. The results of the study show that the suppressive effect on PTH through calcitriol therapy was reduced in patients with detectable enlarged parathyroid glands. This may indicate that the size of parathyroid glands is one factor determining the therapeutic potential of pulsed-dose calcitriol administration for secondary hyperparathyroidism.

Administration, Oral↗
PubMed1998

Ultrastructure of the parathyroid gland of the young golden hamster after short-term treatment with ethanol.

We studied the ultrastructure of the parathyroid gland of young golden hamsters after short-term treatment with ethanol (1.5 g/kg bw or 6.0 g/kg bw). We did not find any ultrastructural changes of the parathyroid gland after administration of 1.5 g/kg ethanol. In the hamsters, 3 hours after administration of 6.0 g/kg ethanol, the mean serum calcium concentration was significantly low as compared to that of the control animals. In the parathyroid gland 1 hour after administration of 6.0 g/kg ethanol, the Golgi complexes associated with a few prosecretory granules and the volume density occupied by the Golgi complexes decreased compared with that of the control animals. In the parathyroid glands 3 hours after administration of 6.0 g/kg ethanol, the Golgi complexes decreased as compared with those of the control animals, while the large vacuolar bodies increased. These findings suggest that the cellular activity of the parathyroid gland is suppressed after short-term treatment with ethanol. Intracellular lumen was found in the parathyroid chief cells 3 hours after administration of 6.0 g/kg ethanol, and the significance of this structure is discussed.

Animals↗
PubMed2001

[Ultrasonography of the parathyroid glands in dogs--a review].

The purpose of the study was to give an overview over the usefulness of ultrasonographic examination of parathyroid glands in dogs. By means of a 10 MHz high-resolution linear transducer it was possible to visualize parathyroid glands in healthy dogs. There was a positive correlation between body weight and size of the parathyroid glands, additionally the likelihood to detect 4 glands increased with an increase in body weight. Dogs with chronic renal failure had significantly larger parathyroid glands than healthy dogs and dogs with acute renal failure. In dogs with hypercalcemia of malignancy either none or parathyroids which were small in relation to body weight were detected. In contrast visualisation of parathyroid masses in dogs with primary hyperparathyroidism was easy due to their increased size and anechoic appearance. In dogs with severe azotemia the ultrasonographic examination of the parathyroid glands is helpful to differentiate between acute and chronic renal failure, in dogs with hypercalcemia to differentiate between hypercalcemia of malignancy and hypercalcemia due to primary hyperparathyroidism.

Acute Kidney Injury↗
PubMed1999

The usefulness of Tc-99m tetrofosmin scintigraphy in the diagnosis and localization of hyperfunctioning parathyroid glands.

PURPOSE: The aim of the work was to study the diagnostic value of Tc-99m tetrofosmin to localize anomalous parathyroid glands in patients with hyperparathyroid disease. METHODS: We studied 31 patients, 19 with primary and 12 with secondary hyperparathyroid disease. Five of these patients were renal graft recipients. All patients underwent surgery. Each patient was injected with 555 to 740 MBq (15 to 20 mCi) Tc-99m tetrofosmin. Subsequently, radionuclide images were acquired 15 and 120 minutes after injection using a low-energy, all-purpose, parallel-hole collimator. Pertechnetate thyroid scintigraphy was obtained in nine cases (24 to 48 h later) when the thyroid activity made it difficult to identify the parathyroid glands. RESULTS: All cases showed tracer uptake as early as 15 minutes after injection. In the group of patients with primary hyperparathyroid disease, 15 showed focal uptake in a parathyroid gland, and surgery revealed an adenoma in the same location. In one patient with hyperplasia, scintigraphy identified only two of four diseased glands. In the three remaining cases, scintigraphy showed focal uptake in the lower parathyroid gland, whereas at surgery the abnormal gland was located in the upper pole. In the secondary hyperparathyroidism group, seven patients showed diffuse tracer uptake in two or more glands, and histologic analysis confirmed hyperplasia in all of them. Five cases showed focal uptake, with three evaluated after surgery (uptake in the only remaining gland); one of them was a renal graft recipient, and the remaining patient had chronic renal failure and was receiving hemodialysis. CONCLUSIONS: Our results suggest that Tc-99m tetrofosmin may be a suitable tracer for preoperative detection and screening of anomalous parathyroid glands. The earlier images at 15 minutes were better than those at 120 minutes. Tc-99m tetrofosmin is cleared more slowly from the normal thyroid than is Tc-99m sestamibi, and both of these tracers may give better results than the old pertechnetate TI-201 subtraction technique.

Adenoma↗
PubMed1992

Vascularized and nonvascularized parathyroid gland transfer: a comparative study.

There is currently no animal model available to study the results of vascularized parathyroid gland autotransfers and nonvascularized autotransfers in the same model. This study was undertaken to determine the technical feasibility of performing microvascular parathyroid gland autotransfers in the dog, and to compare the postoperative levels of calcium, phosphorous, and parathyroid hormone (PTH) levels to a group of dogs who underwent nonvascularized parathyroid gland transfers. Dogs in the nonvascularized group were unable to maintain normal calcium without supplements, whereas dogs in the vascularized group maintained levels in the normal range. Microsurgical techniques allow transplant of a precise amount of parathyroid gland with its vascular supply to another part of the body with almost immediate restoration of function.

Animals↗