J.Jpn. Surg. Soc.. 80(11): 1009-1013, 1979
Report on the annual meeting
SURGICAL MANAGEMENT OF PRIMARY HYPERPARATHYROIDISM
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1) Department of Surgery, Institute of Clinical Medicine, University of Tsukuba Takao Obara1), Yoshihide Fujimoto1), Kyotaro Kanazawa1), Yuji Aiyoshi1), Yukio Ito1), Masatoshi Esaki1), Atsushi Oka2), Ko Hidai2), Tatsuo Wada2), Hideki Nakazawa3), Yuji Takahashi4), Hiroshi Futonaka4) |
The patients were divided into three clinical groups: bone change group, nephrolithiasis group and chemical hyperparathyroidism group. There were so significant differences between each groups in several aspects of clinico-pathological findings that we could roughly predict pathology and size of the affected parathyroid gland preoperatively. In our experience preoperative localization studies were not necessary, so far as the surgical exploration was carried out by experienced surgeons. Intrathymic parathyroid adenoma was found in four patients. In two of those, primary cervico-mediastinal exploration was performed. In patients with single gland enlargement, persistent or recurrent hypercalcemia was not noted postoperatively except for one with parathyroid carcinoma. Hypoparathyroidism occured in four patients who underwent resection of 3 to 3-1/2 glands. The subtotal parathyroidectomy should be reserved only for patients with multiple gland enlargement. Out of six cases with parathyroid carcinoma, three had local recurrence after the operation. Wide en bloc excision is mandatory when the surgeons recognize the possibility of parathyroid malignancy at operation. The association of thyroid carcinoma and hyperparathyroidism was recognized in 13 patients. The incidence of the coexistence is unexpectedly high, so that we urge careful serum calcium determination in all patients with thyroid nodule preoperatively.
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