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Surgical Treatment of Hyperparathyroidism in Patients With MEN I

Laura Lambert, Jeffrey E Lee, Suzanne Shapiro, Douglas B Evans
M.D. Anderson Cancer Center, Houston, TX

Table of Contents
Objective:
To determine the optimal surgical treatment for hyperparathyroidism in patients with MEN1.
Design:
Retrospective cohort study
Setting:
Tertiary referral center
Patients: From 1973 to 2004, 35 patients with MEN1 underwent one or more surgical procedures for hyperparathyroidism.
Results:
At initial parathyroid surgery, 12 (34%) of 35 patients had < 3 parathyroid glands resected, 18 (51%) had 3 and 1/2 glands resected, and 5 (14%) had 4 or more glands resected. Follow-up is complete for 32 of 35 patients. Recurrent hyperparathyroidism developed in 20 (63%) of 32 patients at a median of 3.7 years. Reoperative parathyroid surgery was performed in 13 (41%) of 32 patients including 9 (75%) of 12 patients with < 3 glands removed and 4 (22%) of 18 patients with 3 and 1/2 glands removed. No patient with 4 or more glands removed during initial operation required reoperative cervical surgery. However, permanent hypoparathyroidism occurred in 1 patient after 4 gland resection, despite autotransplantation of parathyroid tissue to the forearm. Parathyroid autotransplantation was performed in 22 (63%) of 35 patients. Function has been confirmed in 13 (59%) autografts. Two patients required partial autograft debulking for recurrent hypercalcemia.
Conclusions:
Recurrent hyperparathyroidism in MEN I patients is frequent if < 3 glands are removed at initial parathyroidectomy. Optimal surgical intervention must balance the risk of recurrent hypercalcemia with the morbidity of permanent hypoparathyroidism. Three gland parathyroidectomy, transcervical thymectomy and cryopreservation is our preferred initial surgical procedure.

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