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Management of Medullary Thyroid Cancer
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Serum calcium and PTH levels should be obtained pre-operatively. Hypercalcaemia or inappropriate serum PTH will indicate the need for careful assessment of the parathyroid glands at the time of thyroidectomy and excision of enlarged glands.
The patient with acute endocrine problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Two pairs of parathyroid glands are embedded in the posterior surface of the thyroid gland (see Figure 11.3). The thyroid makes and stores thyroid hormones (T3 and T4), and it is able to hold up to a 100 days’ supply. Iodine is necessary for the production of thyroid hormones. Thyroid hormones affect virtually every organ in the body and increase metabolic rate. The parathyroid glands produce parathyroid hormone (PTH), which regulates serum calcium levels. PTH secretion is stimulated when ionised serum calcium falls. This hormone influences the bones and the kidneys, leading to restoration of normal calcium levels (bone resorption and increased renal tubular calcium reabsorption, respectively).
Endocrine surgery
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Ross M. Warner, Richard Boulton
The parathyroid glands control calcium and phosphate blood levels through the release of PTH. This acts on the bones (osteoblasts) to increase calcium and phosphate absorption and on the kidneys to increase calcium reabsorption, but block phosphate reabsorption (the kidneys therefore retain calcium and excrete phosphate). This leads to a net rise in serum calcium and fall in serum phosphate. It also converts vitamin D to its active metabolite (1,25-dihydroxyvitamin D3), which works synergistically to increase serum calcium levels.
Parathyroid carcinoma in chronic renal disease – a case series of three patients and review of literature
Published in Acta Chirurgica Belgica, 2023
Vladan Zivaljevic, Rastko Zivic, Nikola Slijepcevic, Matija Buzejic, Dusko Dundjerovic, Jasna Trbojevic Stankovic, Dejan Stojakov, Milan Jovanovic, Ivan Paunovic
The pathophysiology of diffuse and nodular hyperplasia in ESRD patients is well known, but the pathogenesis of parathyroid carcinoma in this cohort remains unclear. In response to the increased demand (decreased production of calcitriol, elevated phosphate levels, and subsequently elevated PTH), parathyroid cells start to proliferate, leading to diffuse hyperplasia [32]. If some of the cells escape from the cell cycle control mechanisms and proliferate on their own, they may form small nodules. When these nodules enlarge even more and become encapsulated, these glands are described as nodular hyperplasia [34]. Although there is no hard evidence, the authors agree with Berland et al. that a sustained stimulus of hyperphosphataemia and high levels of PTH on the parathyroid glands may lead to parathyroid hyperplasia, and potentially may even lead to neoplastic transformation [8].
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.