Parathyroid hyperplasia subtotal pararthyroidectomy

 The main indications for parathyroid autotransplantation are currently well dened: (1) for surgical treatment of primary hyperparathyroidism due to multiglandular disease

primary hyperplasia either associated or not with MEN syndromes); (2) in secondary hyperparathyroidism; (3) in repeat surgical exploration for persistent or recurrent hyperparathyroidism; and (4) during total thyroidectomy for thyroid carcinoma or benign disease (normal functioning and hyperfunctional multinodular goiter) and in cancer surgery in the anterior neck compartment

Parathyroid hyperplasia involves enlargement of all four parathyroid glands, which are located in the neck and control calcium metabolism.

Treatment: Surgery is the preferred treatment. Usually 3 1/2 glands are removed. The remaining tissue may be implanted in the forearm to regulate calcium levels but allow easy surgical access if hypercalcemia recurs.

For familial diseases, such as MEN 1, total parathyroidectomy is performed along with cervical thymectomy and autotransplantation to the forearm. Cryopreservation of some parathyroid tissue is also recommended.

With modern imaging techniques, an abnormal parathyroid may be detected preoperatively in 70-80% of cases. However, no current imaging study is reliable for detecting multiple abnormal glands.[3]Therefore, an additional method is required to confirm that no other abnormal glands are present after excision of the imaged lesion. For this purpose, most centers use the intraoperative parathyroid hormone assay.[3, 34, 35]Because the plasma half-life of parathyroid hormone is only approximately 4 minutes, the level falls quickly after resection of the source. If the level fails to fall after resection of the identified abnormal gland, the procedure is extended to allow for further exploration. However, the intraoperative parathyroid hormone assay is usually available only in centers that perform a high volume of parathyroidectomies.

Rather than explore all parathyroid glands, a newer technique, directed parathyroidectomy, has evolved. This technique relies on preoperative imaging studies to localize the abnormal gland. The surgeon then removes only that gland, without visualizing the other glands

Approximately 85% of cases of primary hyperparathyroidism are caused by a single adenoma.