Resection of supernumerary mediastinal parathyroid as a treatment for persistent secondary hyperparathyroidism

Secondary refractory hyperparathyroidism (SHPT) is usually resolved with total parathyroidectomy. On the other hand, SHPT is associated with persistent hyperparathyroidism as a result of inadequate resection of the parathyroid tissue or by a fifth gland not previously detected. The objective of this work is to present the case of a patient with persistent SHPT and the surgical strategy used for the resection of a hyperfunctional ectopic parathyroid in the thorax.

48-year-old female, with a history of chronic kidney disease with persistent SHPT, as well as subtotal parathyroidectomy, subsequent resection of parathyroid remnants twice. She was treated with medical management without obtaining adequate response. Previous location of hypercaptant lesion by single photon emission computed tomography, the patient underwent a sternotomy with 3 × 2 cm mediastinal ectopic parathyroid fixed to aortic root. The patient evolved satisfactorily with a decrease in parathyroid hormone levels, with a 18-month follow-up of the procedure with normal paratohormone values and entered the renal transplant protocol while waiting for a donor.

Sternotomy is a safe approach to perform parathyroidectomy of the ectopic gland, provided that it is well identified the site of the lesion and there are specific conditions appropriate to perform the procedure.