Reoperative parathyroid surgery for persistent hyperparathyroidism.

Authors:
  • MBM F Brennan
    M F Brennan
  • JDJ L Doppman
    J L Doppman
  • SMS J Marx
    S J Marx
  • ASA M Spiegel
    A M Spiegel
  • EBE M Brown
    E M Brown
  • GAG D Aurbach
    G D Aurbach
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  • 1 June 1978
    • journal article
    • Vol. 83  (6) , 669-76
    • PMID:644460
Abstract
In a 2-year period 30 patients with persistent hyperparathyroidism following 59 prior unsuccessful procedures underwent reoperation. Preoperative arteriography was useful in planning the surgical approach in 56%, and retrospectively was correct in 63%. Selective venous catheterization gave localizing information in 83%, correctly predicting site or side in 60% of the total. Computerized axial tomography was helpful in identifying mediastinal glands before operation. Reoperation was successful in rendering the patient hypocalcemic or normocalcemic in 83%. Of the 11 patients (37%) who were rendered profoundly hypocalcemic, two were subsequently weaned from vitamin D and calcium support; seven have received either fresh or cryopreserved parathyroid autografts. Persistent hyperparathyroidism is a difficult surgical problem which we believe warrants aggressive localization attempts prior to operation. Autotransplantation with cryopreserved parathyroid tissue may be of value in the long-term management of the high incidence of postoperative hypocalcemia in this patient group.