IDENTIFICATION OF PATHOLOGICAL 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 o f 32 patients who underwent parathyroidectomy at our institution in th e past 14 gears for primary hyperparathyroidism were reviewed, Twenty- three patients had a single lesion while 9 had multiple-gland involvem ent. Localization studies identified 17 of 23 patients with a single l esion. All patients with multiple lesions were diagnosed with an enlar gement of the parathyroids, but not all glands were identified in each patient preoperatively. At surgery, 8 of 32 patients were explored un ilaterally. Solitary enlarged glands were resected, and a subtotal par athyroidectomy was performed for multiple-gland involvement. The intra operative serum intact parathyroid hormone (PTH) level dropped after r esection of the largest gland, The serum PTH level correlated with the gland size (r = 0.861, intact PTH assay). Eight of 9 patients with mu ltiple-gland involvement had an elevated serum PTH (>2000 pg/ml in mid portion 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 o ur cases. It is usual to explore all glands during surgery, and in cas es with a high serum PTH level, multiple-gland involvement should also be considered.