Archives of Head and Neck Surgery
Archives of Head and Neck Surgery
Original Article Parathyroid diseases and tumors

Less-than-subtotal parathyroidectomy as treatment for primary hyperparathyroidism in multiple endocrine neoplasiatype 1: a good option?

Yasmin Laryssa Moura Guimarães, Thaila Pine Gondek, Fábio Luiz De Menezes Montenegro, Delmar Muniz Lourenço Junior, Sérgio Samir Arap, Marília D´Elboux Guimarães Brescia

Downloads: 0
Views: 232


Introduction: Multiple endocrine neoplasia type 1 (MEN1) is a genetic syndrome manifested initially as primary hyperparathyroidism (HPT/MEN 1). The treatment is classically surgical with total parathyroidectomy with autograft or subtotal parathyroidectomy. In order to maintain normal postoperative function, less than subtotal parathyroidectomy (LTSPTx) has been suggested as an alternative technique. Objective: Analyse critically LTSPTx as a treatment option for patients with HPT/MEN 1. Methods: A retrospective cohort study of patients submitted to LTSPTx from january 2011 to december 2018. Data from demographics, laboratory tests, 6 months postoperative clinical outcomes, intraoperative PTH values and localization studies were analized. Results: LTSPTx was performed non-intentionally in 13 patients and intentionally in 13 other cases; 17 females and 9 males. The mean age was 44 years, but in patients with identified mutation it was 37 years. Seventeen patients (65.4%) had normal parathyroid function, 5 (19.2%) had hypoparathyroidism, in all of them LTSPTx was performed non intentionally. Four patients (15.4%) had persistence, all submitted intentionally to LTSPTx. The mean intraoperative PTH drop was 85.5% (±10.4%), without difference intergroup. A patient with persistence had PTH intraoperative drop > 80%, which also occurred in another patient with postoperative hypoparathyroidism. No persistence was found in patients with concordant image exams, what happened in three cases with non-concordant studies. Conclusion: LTSPTx may be intentionally performed as treatment for HPT/MEN 1, however social aspects, technical expertise, image exams and patient expectations must be taken into account.


parathyroidectomy; type 1 multiple endocrine neoplasia; hypoparathyroidism.


1. Chandrasekharappa SC, Guru SC, Manickam P, Olufemi SE, Collins FS, EmmertBuck MR, Debelenko LV, Zhuang Z, Lubensky IA, Liotta LA, Crabtree JS, Wang Y, Roe BA, Weisemann J, Boguski MS, Agarwal SK, Kester MB, Kim YS, Heppner C, Dong Q, Spiegel AM, Burns AL, Marx SJ. Positional cloning of the gene for multiple endocrine neoplasia-type 1. Science. 1997;276(5311):404-7. PMid:9103196.

2. Guru SC, Goldsmith PK, Burns AL, Marx SJ, Spiegel AM, Collins FS, Chandrasekharappa SC. Menin, the product of the MEN1 gene, is a nuclear protein. Proc Natl Acad Sci USA. 1998;95(4):1630-4. PMid:9465067.

3. Agarwal SK, Impey S, McWeeney S, Scacheri PC, Collins FS, Goodman RH, Spiegel AM, Marx SJ. Distribution of menin-occupied regions in chromatin specifies a broad role of menin in transcriptional regulation. Neoplasia. 2007;9(2):101-7. PMid:17356705.

4. Montenegro FLM, Brescia MDEG, Lourenço DM Jr, Arap SS, d’Alessandro AF, de Britto e Silva Filho G, Toledo SPA. Could the less-than subtotal parathyroidectomy be an option for treating young patients with multiple endocrine neoplasia Type-1 related hyperparathyroidism? Front Endocrinol. 2019;10:123. PMid:30899245.

5. Arnalsteen LC, Alesina PF, Quiereux JL, Farrel SG, Patton FN, Carnaille BM, Cardot-Bauters CM, Wemeau JL, Proye CA. Long-term results of less than total parathyroidectomy for hyperparathyroidism in multiple endocrine neoplasia type 1. Surgery. 2002;132(6):1119-25, discussion 1124-5. PMid:12490864.

6. Fyrsten E, Norlén O, Hessman O, Stalber P, Hellman P. Long-term surveillance of treated hyperparathyroidism for multiple endocrine neoplasia type 1: recurrence or hypoparathyroidism? World J Surg. 2006;40(3):615-21. PMid:26541865.

7. Kluijfhout WP, Beninato T, Drake T, Vriens MR, Gosnell J, Shen WT, Suh I, Liu C, Duh QY. Unilateral clearance for primary hyperparathyroidism in selected patients with multiple endocrine neoplasia type 1. World J Surg. 2016;40(12):2964-9. PMid:27402205.

8. Lourenço DM Jr, Toledo RA, Coutinho FL, Margarido LC, Siqueira SAC, Santos MACG, Montenegro FLM, Machado MCC, Toledo SPA. The impact of clinical and genetic screenings on the management of the multiple endocrine neoplasia type 1. Clinics (São Paulo). 2007;62(4):465-76. PMid:17823710.

9. Doherty GM, Lairmore TC, DeBenedetti MK. Multiple endocrine neoplasia type 1 parathyroid adenoma development over time. World J Surg. 2004;28(11):1139-42. PMid:15490065.

10. Versnick M, Popadich A, Sidhu S, Sywak M, Robinson B, Delbridge L. Minimally invasive parathyroidectomy provides a conservative surgical option for multiple endocrine neoplasia type 1–primary hyperparathyroidism. Surgery. 2013;154(1):101-5. PMid:23809488.

11. Montenegro FLM, Lourenço-Jr DM, Tavares MR, Arap SS, Nascimento-Jr CP, Massoni LM NO, D’Alessandro A, Toledo RA, Coutinho FL, Brandão LG, Silva GB FO, Cordeiro AC, Toledo SPA. Total parathyroidectomy in cases with hyperparathyroidism associated with MEN1. Clinics (São Paulo). 2012;67(S1):131-9. PMid:22584718.

12. Coutinho FL, Lourenco DM Jr, Toledo RA, Montenegro FL, Correia-Deur JE, Toledo SP. Bone mineral density analysis in patients with primary hyperparathyroidism associated with multiple endocrine neoplasia type 1 after total parathyroidectomy. Clin Endocrinol (Oxf). 2010;72(4):462-8. PMid:19650788.

13. Brescia MDG, Jr DL, Alessandro AFD, Jr CPN, Neto LMM, et al. Oral presentation and 05.4 Late onset of euparathyroidism after total parathyroidectomy with autograft in MEN1. In: Proceedings of the 15th Internacional Workshop on Multiple Endocrine Neoplasia and other rare endocrine tumors; 2016 Sep 29-Oct 1; Utrecht, The Netherlands. Cidade: editora; 2016.

14. Hubbard JG, Sebag F, Maweja S, Henry JF. Subtotal parathyroidectomy as an adequate treatment for primary hyperparathyroidism in multiple endocrine neoplasia type 1. Arch Surg. 2006;141(3):235-9. PMid:16549687.

15. Tonelli F, Giudici F, Cavalli T, Brandi ML. Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy. Clinics (São Paulo). 2012;67(1, Suppl 1):155-60. PMid:22584722.

16. Pieterman CR, van Hulsteijn LT, den Heijer M, van der Luijt RB, Bonenkamp JJ, Hermus AR, Borel Rinkes IH, Vriens MR, Valk GD, DutchMEN1 Study Group. Primary hyperparathyroidism in MEN1 patients: a cohort study with longterm follow-up on preferred surgical procedure and the relation with genotype. Ann Surg. 2012;255(6):1171-8. PMid:22470073.

17. Goudet P, Cougard P, Vergès B, Murat A, Carnaille B, Calender A, Faivre J, Proye C. Hyperparathyroidism in multiple endocrine neoplasia type I: surgical trends and results of a 256-patient series from Groupe D’etude des Néoplasies Endocriniennes Multiples Study Group. World J Surg. 2001;25(7):886-90. PMid:11572029.

18. Horiuchi K, Sakurai M, Haniu K, Nagai E, Tokumitsu H, Yoshida Y, Omi Y, Sakamoto A, Okamoto T. Impact of ‘“Tailored”’ parathyroidectomy for treatment of primary hyperparathyroidism in patients with multiple endocrine neoplasia type 1. World J Surg. 2017;42(6):1772-8. PMid:29138914.

19. Ohe MN, Santos RO, Kunii IS, Abrahão M, Cervantes O, Carvalho AB, LazarettiCastro M, Vieira JG. Utilidade da medida de PTH intra-operatório no tratamento cirúrgico do hiperparatiroidismo primário e secundário: análise de 109 casos. Arq Bras Endocrinol Metabol. 2006;50(5):869-75. PMid:17160210.

5e7e5d1d0e88259512e1a446 archives Articles
Links & Downloads

Arch. Head Neck Surg.

Share this page
Page Sections