HYPERPARATHYROIDISM WITH INTRATHYROIDAL P ARATHYROID-GLANDS - A REVIEW OF 43 CASES

The rate of occurrence of intrathyroidal parathyroid glands in patient s treated surgically for hyperparathyroidism (HPT) varies across studi es. Among 1200 consecutive patients who underwent surgery for HPT at t he Lille Hospital, France, between December 1965 and July 1992, 43 (3. 6%) had 47 histologically-proven intrathyroidal parathyroid glands, in cluding 44 lower and three upper parathyroid glands. Fifteen patients had a thyroid gland abnormality. Of the 14 patients who had a preopera tive ultrasound study, eight exhibited an abnormal image. Thirty-four of the 47 intrathyroidal parathyroid glands were visible at the surfac e of the thyroid gland, five were felt on palpation, and eight were di scovered upon examination of a lobectomy specimen. A normal or abnorma l parathyroid gland can be completely concealed within the thyroid gla nd, even in the absence of concomitant thyroid gland disease. In most cases, the ectopia affects one or both lower parathyroid glands, altho ugh in some instances the two glands on the same side are intrathyroid al. There is no fail-proof means for detecting intrathyroidal parathyr oid glands preoperatively. An apparently missing fourth parathyroid gl and or a fifth gland should be looked for in the thyroid gland when th e cause of HPT is not found during a first cervicotomy procedure. Pre- or intra-operative ultrasonography may be the most informative imagin g method for detecting intrathyroidal parathyroid glands and should be performed routinely when a repeat procedure for persistent HPT is bei ng considered.