A patient with primary hyperparathyroidism undergoes neck exploration where four small, normal appearing glands are found. What are the possible locations of an additional, supernumerary gland?
Supernumerary parathyroid glands occur in 7 to 13% of people, and may be located in the thymus (most commonly), within the parenchyma of the thyroid gland, or in the tracheoesophageal groove, the mediastinum, or elsewhere in the neck.
A 70-year-old woman with early dementia but otherwise good physical health has an elevated parathyroid hormone (PTH) level and a sestamibi scan which localizes a single focus of increased activity to the left lower neck. An ultrasound confirms an enlarged gland in the same area. What treatment is likely to provide the best outcome?
Localization studies such as sestamibi scans have been shown to allow more limited operations, including those utilizing "mini-incisions" under local anesthesia, for patients who are not good risks for general anesthesia. Improved cosmesis, shorter lengths of stay, and reduced complications are benefits from this approach.
Intraoperative, rapid PTH assays provide guidance that all hyperfunctioning glands have been removed during parathyroidectomy. What criterion is used to indicate satisfactory resolution of the hyperparathyroidism during the procedure?
When the PTH level falls by greater than 50% within 10 minutes after removal of parathyroid tissue, the cause of the hyperparathyroidism is likely to have been removed, and the operation can be stopped.
A patient with persistent ulcer disease is diagnosed with a gastrinoma. Serum chemistry studies indicate hypercalcemia, and an elevated PTH level is documented. What is the indicated course of treatment?
In patients with MENl, hyperparathyroidism should be corrected before treatment of the gastrinoma because resolution of hypercalcemia may allow gastrin levels to fall to normal.
Which of the following findings is suggestive of a parathyroid carcinoma?
Parathyroid carcinoma occurs in about 1% of patients with primary hyperparathyroidism, or in about 1000 patients per year in the United States. Findings include an elevated serum calcium level greater than 14 mg/dL, and elevated PTH level greater than five times normal, and a palpable mass in the neck, but none of these may be present. Complete surgical removal is the most effective therapy with radical neck dissection if lymphadenopathy is present; however, one-third of patients have metastatic disease when first diagnosed.
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