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[Intrathyroid parathyroid adenomas: right and lower]
Susana Ros1, Antonio Sitges-Serra, José Antonio Pereira
1Unidad de Cirugía Endocrina, Hospital Universitario Arnau de Vilanova, Lleida, España. jrros@telefonica.net
Cirugia Espanola
|October 22, 2008
Summary
Intrathyroidal parathyroid adenomas (IPA) are found in 3% of patients undergoing parathyroidectomy. Thyroid resection is recommended over enucleation to prevent recurrence of persistent hyperparathyroidism.
Area of Science:
- Endocrinology
- Surgical Pathology
- Thyroid Surgery
Background:
- Intrathyroidal parathyroid adenomas (IPA) are a recognized cause of persistent hyperparathyroidism.
- Their prevalence, embryological origin, and precise location within the thyroid remain subjects of debate.
Purpose of the Study:
- To determine the prevalence and characteristics of intrathyroidal parathyroid adenomas (IPA).
- To evaluate the surgical outcomes and recurrence rates associated with different management strategies for IPA.
Main Methods:
- Retrospective review of surgical protocols for 574 patients undergoing parathyroidectomy.
- Identification and analysis of 17 intrathyroidal parathyroid adenomas (IPA) based on embryological origin, thyroidal position, and surgical approach.
Main Results:
- Intrathyroidal parathyroid adenomas (IPA) were detected in 3.2% of patients, predominantly in the right thyroid lobe.
- Twelve (70.6%) IPAs were identified during initial surgery; thyroid resection resulted in no recurrences, unlike incomplete enucleations.
- Five IPAs were missed initially, leading to persistent disease and reoperations.
Conclusions:
- Intrathyroidal parathyroid adenomas (IPA) occur in approximately 3% of parathyroidectomy patients and frequently cause persistent hyperparathyroidism.
- These adenomas, originating from the third or fourth pharyngeal pouch or as supernumerary glands, favor the right thyroid lobe.
- Surgical management via thyroid resection offers superior outcomes compared to enucleation due to the high risk of recurrence from incomplete resection of IPAs.
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