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Body fluids and electrolytes
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Hypercalcaemia usually requires the patient to be nursed in hospital under specialist advice. A patient with chronic hypercalcaemia is prone to pathological fractures and may need assistance to reposition, if bedridden. The patient may require intravenous fluids to increase the urinary output of calcium as well as the administration of drugs to inhibit bone reabsorption. Haemodialysis may be required if the condition is secondary to renal failure. Surgery to remove part of the parathyroid gland may also be considered.
Surgery
Published in Seema Khan, Get Through, 2020
Hypoparathyroidism due to inadvertent removal or injury to the parathyroid glands during thyroidectomy can lead to low serum calcium. Other complications of this operation include recurrent laryngeal nerve palsy, hypothyroidism and tracheal obstruction from haematoma formation.
The endocrine system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
The parathyroid glands are small glands lying posterior to the thyroid, there are usually four present, two at the upper and two at the lower poles of the thyroid gland. However, the parathyroids may lie in the lower neck, mediastinum or in an intra-thyroidal position. The ectopic position of parathyroid tissue is attributable to defective migration during embryological development. So varied are the potential locations of parathyroid tissue that a Technetium (99mTc) Sestamibi scan may be required to accurately locate pathological parathyroid glands.
The Value of Preoperative and Intraoperative Ultrasound in the Localization of Intrathyroidal Parathyroid Adenomas
Published in Journal of Investigative Surgery, 2022
Wei Zhao, Ruigang Lu, Li Yin, Bojun Wei, Mulan Jin, Chun Zhang, Ruijun Guo, Xiuzhang Lv
The ultrasound apparatus used was Aplio 500 system (Canon Medical, Inc., Otawara, Tochigi, Japan) with PLT-1005BT 15L4 and PLT-1202S 17L7 linear probes. Ultrasonographic examinations were performed by a senior radiologist with more than 16 years of experience in neck ultrasound examination. Gray-scale and color doppler ultrasonography were used to examine the thyroid and parathyroid region. The patient was placed in a supine position with the neck exposed sufficiently and the head was tilted to the opposite side to allow scanning of multiple sections. The key areas of scanning were the dorsal and inferior side of thyroid and the dorsal and superior side of thyroid. Abnormalities of the parathyroid glands were recorded. Additionally, the location, size, border, shape, internal echo, hyperechoic line on the margins of the nodules, blood flow signals and the artery supplying the intrathyroidal parathyroid nodules were recorded.
Surgical management of primary hyperparathyroidism during pregnancy: a systematic review of the literature
Published in Gynecological Endocrinology, 2021
Constantinos Nastos, Anna Paspala, Ioanna Mavroeidi, Fotios Stavratis, Vaia Lampadiari, Sophia Kalantaridou, Melpomeni Peppa, Emmanuil Pikoulis
After the appropriate preoperative work-up in order to localize the abnormal parathyroid glands, parathyroidectomy is a safe and feasible therapeutic option in symptomatic women and in women diagnosed with GPHPT and with serum calcium levels higher than 11.4 mg/dl [64]. Parathyroidectomy should be performed in the second trimester of gestation, although some authors prefer to delay surgery until after birth [5]. In our study several techniques have been reported, such as MIP, BNE, Video-assisted BNE, VATS, and traditional approaches like parathyroidectomy of mediastinal gland through thoracotomy [5]. In general, both BNE and MIP with the use of IOPTH seem to have comparable cure rates in patients with localized PHPT and both are considered safe when performed by experienced Endocrine surgeons [65]. Although MIP has shorter operation times and a theoretical advantage of somewhat less risk of complications, the lack of availability of sensitive and specific preoperative localization studies dictates the preference of BNE as the gold standard surgical approach in GPHPT as the most important goal is to cure the patient by the first attempt, without the need of reoperation and further reevaluation [10,11,20,66]. Finally, in cases of localized disease and in patient of high anesthetic risk or unwilling to undergo anesthesia, excision under local anesthetic can be performed, through with a higher rate of failure to cure [15].
Correlations of neck ultrasound and pathology in cervical lymph node of papillary thyroid carcinoma
Published in Acta Chirurgica Belgica, 2020
Bassam Abboud, Tarek Smayra, Hicham Jabbour, Claude GHORRA, Gerard Abadjian
Their mean age was 56 years (14–88 years). Female patients numbered 152 (74%). The age was not different between both genders. Substernal thyroid extension was found in 14 patients (7%). The thyroid function was normal in 198 patients (96%), while four patients (2%) were hyperthyroid and four patients (2%) were hypothyroid. Total thyroidectomy was performed in 192 patients (93%), and near total in 14 patients (7%). Both recurrent laryngeal nerves were identified in 173 cases (84%) and one recurrent laryngeal nerve in 27 cases (13%); No recurrent laryngeal nerve was identified in the six cases (3%). The number of identified parathyroid glands were four in 161 patients (78%), three in 39 patients (19%), two in four patients (2%), and one in two patients (1%). Weight of the thyroid tissue averaged 33g (26 g–134 g). The pathological diagnoses of the resected tumors showed papillary carcinomas in 100% (n = 206) of cases. Tumor size varied from 0.5 to 10 cm. Central and lateral lymph nodes were involved in 68% (n = 141 patients; 141/206) and 60% (n = 34 patients; 34/57) of cases, respectively.