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Laura A. Lambert, MD; Suzanne E. Shapiro, MS; Jeffrey E. Lee, MD; Nancy D. Perrier, MD; Mylene Truong, MD; Michael J. Wallace, MD; Ana O. Hoff, MD; Robert F. Gagel, MD; Douglas B. Evans, MD

Arch Surg. 2005;140:374-382.

Hypothesis  Three-gland parathyroidectomy with transcervical thymectomy and cryopreservation is the preferred initial surgical approach for hyperparathyroidism (HPT) in patients with multiple endocrine neoplasia type 1.

Design  Retrospective cohort study.

Setting  Tertiary referral center.

Patients  Thirty-seven patients with multiple endocrine neoplasia type 1 who underwent 1 or more surgical procedures for HPT from January 1, 1973, to April 30, 2004.

Results  At initial parathyroid surgery, 16 (43%) of 37 patients had fewer than 3 parathyroid glands resected (group 1); 16 (43%), had at least 3 but fewer than 4 glands (group 2); and 5 (14%), 4 or more glands (group 3). Follow-up of at least 6 months after initial surgery was complete for 31 (84%) of 37 patients. Recurrent HPT developed in 20 (65%) of 31 at a median of 4 years. Reoperation for recurrent HPT was performed in 16 (52%) of 31, including 12 patients (75%) in group 1 and 4 (25%) in group 2. No patient in group 3 required reoperative cervical surgery. Permanent hypoparathyroidism occurred in 1 patient (3%), despite autograft of parathyroid tissue to the forearm.

Conclusions  Recurrent HPT in patients with multiple endocrine neoplasia type 1 is frequent if fewer than 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 parathyroid cryopreservation constitute our preferred initial surgical procedure.

Author Affiliations: Departments of Surgical Oncology (Drs Lambert, Lee, Perrier, and Evans and Ms Shapiro), Diagnostic Radiology (Drs Truong and Wallace), and Endocrinology (Drs Hoff and Gagel), The University of Texas M. D. Anderson Cancer Center, Houston (Drs Lambert, Lee, Perrier, Truong, Wallace, Hoff, Gagel, and Evans and Ms Shapiro).

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