REOPERATIVE PARATHYROID SURGERY FOR PRIMARY HYPERPARATHYROIDISM CAUSED BY MULTIPLE-GLAND DISEASE - TOTAL PARATHYROIDECTOMY AND AUTO-TRANSPLANTATION WITH CRYOPRESERVED TISSUE

  • 1 January 1982
    • journal article
    • research article
    • Vol. 91  (6) , 616-621
Abstract
Between Sept. 1975 and June 1980, 27 patients with primary hyperparathyroidism caused by multiple-gland disease underwent reoperative parathyroid surgery. In an effort to minimize persistence and recurrence a strategy of attempting total parathyroidectomy was adopted. Immediate autotransplantation was not performed, but rather tissue was assessed in vitro for suppressibility and was cryopreserved. Patients with prolonged postoperative hypopararthyroidism underwent autotransplantation with cryopreserved tissue. Of 26 surviving patients, 23 (88%) were cured of hypercalcemia. Although 13 had hypoparathyroidism at the time of discharge, 4 of these 13 no longer required Ca or vitamin D within 1 yr. At follow-up, 17 were normocalcemic without medication (14 without and 3 with autografts). Thirteen patients had 4 or 5 glands removed. Two of these remain hypercalcemic, and at follow-up 9 were normocalcemia without medication (7 without and 2 with autografts). Patients with multiple-gland disease, even those undergoing total parathyroidectomy, remain at risk for persistent or recurrent hypercalcemia. Such patients do not inevitably acquire hypoparathyroidism, and normocalcemia in patients undergoing immediate autotransplantation need not be attributed to the autograft. Selective, deferred autotransplantation with cryopreserved tissue prevents confusion regarding the source of postoperative hypercalcemia should it occur, minimizes the risk of graft-dependent hypercalcemia by restricting autotransplantation to those truly in need of additional tissue, and can effectively manage hypoparathyroidism.