Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 662–668 | Cite as

Value of Prophylactic Cervical Thymectomy in Parathyroid Hyperplasia

  • Melissa M. Boltz
  • Ning Zhang
  • Carrie Zhao
  • Sujan Thiruvengadam
  • Allan E. Siperstein
  • Judy Jin
Endocrine Tumors

Abstract

Background

In parathyroid hyperplasia (HPT), parathyroid glands within the cervical thymus are a cause for recurrence. As a result of differences in pathophysiology, variable practice patterns exist regarding performing bilateral cervical thymectomy (BCT) in primary hyperplasia versus hyperplasia from renal failure or familial disease. The objective of this study was to capture patients where thymic tissue was found with subtotal parathyroidectomy (PTX) and intended BCT, identify number of thymic supernumerary glands (SNGs), and determine overall cure rate.

Methods

Retrospective review of patients with four-gland exploration and intended BCT for HPT from 2000 to 2013 was performed. Identification of thymic tissue and SNGs were determined by operative/pathology reports. Univariate analysis identified differences in cure rate for patients undergoing subtotal PTX with or without BCT.

Results

Thymic tissue was found in 52 % of 328 primary HPT (19 % unilateral, 33 % bilateral), 77 % of 128 renal HPT (28 % unilateral, 49 % bilateral), and 100 % of familial HPT (24 % unilateral, 76 % bilateral) patients. Nine percent of primary, 18 % of renal, and 10 % of familial HPT patients had SNGs within thymectomy specimens. Cure rates of primary HPT patients with BCT were 99 % compared to 94 % in subtotal PTX alone. Renal HPT cure rates were 94 % with BCT compared to 89 % without BCT.

Conclusions

Renal HPT patients benefited most in cure when thymectomy was performed. Although the rate of SNGs found in primary HPT was lower than renal HPT, the cure rate mimicked the pattern in renal disease. Furthermore, the incidences of SNGs in primary and familial HPT were similar. On the basis of these data, we advocate that BCT be considered in primary HPT when thymic tissue is readily identified.

Keywords

Parathyroid Gland Thymic Tissue Parathyroid Hyperplasia Bilateral Exploration Permanent Hypocalcemia 

Notes

Disclosure

None.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Melissa M. Boltz
    • 1
  • Ning Zhang
    • 1
  • Carrie Zhao
    • 2
  • Sujan Thiruvengadam
    • 2
  • Allan E. Siperstein
    • 1
  • Judy Jin
    • 1
  1. 1.Department of Endocrine Surgery, Endocrine and Metabolism InstituteCleveland ClinicClevelandUSA
  2. 2.Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandUSA

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