Elsevier

Surgery

Volume 152, Issue 6, December 2012, Pages 1193-1200
Surgery

American Association of Endocrine Surgeon
Intrathyroidal parathyroid glands: Small, but mighty (a Napoleon phenomenon)

https://doi.org/10.1016/j.surg.2012.08.026Get rights and content

Background

Intrathyroidal parathyroid adenomas (ITPAs) are a rare entity. The aim of this study is to describe the experience of 2 endocrine surgery centers and to distinguish characteristics of intrathyroidal parathyroid adenoma and nonintrathyroidal parathyroid adenomas.

Methods

We included patients who had undergone operations for primary hyperparathyroidism who had intrathyroidal parathyroid adenomas. Patients with single intrathyroidal parathyroid adenomas were also compared to age- and sex-matched controls with nonintrathyroidal parathyroid adenomas.

Results

Of 4,868 patients who underwent parathyroidectomy between January 2002 and June 2011, we identified 53 (1%) patients with intrathyroidal parathyroid adenoma. Sestamibi and ultrasound scans correctly identified the adenoma in 35 (70%) and 11 (61%) cases, respectively. Single adenomas were identified in 44 (83%) patients, double adenomas in 4 (8%) patients, and hyperplasia in 5 (9%) patients. Lobectomy was performed in 17 (32%) patients; enucleation was used in 36 (68%) patients. Cure was achieved in all patients and no patients experienced a recurrence. Patients with single intrathyroidal parathyroid adenomas had significantly smaller glands than patients with nonintrathyroidal parathyroid adenomas (325 ± 47 vs 772 ± 61 mg; P < .0001); however, no significant difference was identified between the groups with regard to demographics, symptoms, preoperative laboratory values, or outcomes.

Conclusion

Single intrathyroidal parathyroid adenomas are smaller than nonintrathyroidal parathyroid adenomas, but patients with intrathyroidal parathyroid adenomas present with similar laboratory values and symptoms. Recognition of this rare entity can lead to a successful surgical outcome.

Section snippets

Methods

A review of the prospective databases from The Johns Hopkins University School of Medicine and the University of Wisconsin Endocrine Surgery Sections was performed in order to identify all patients who underwent parathyroidectomy for primary hyperparathyroidism between January 2002 and June 2011. Institutional approval was obtained from the institutional review boards at both centers. The operative and pathology reports were reviewed to identify patients who had parathyroid adenomas within the

Results

Between 2002 and 2011 4,868 patients underwent parathyroidectomy at 1 of the 2 institutions, and 101 were labeled intrathyroidal. Of these, 53 (1%) cases were identified as true intrathyroidal glands that were entirely within the thyroid parenchyma. The mean patient age was 54 ± 2 years, and 77% of patients were female. Four (8%) patients had undergone previous parathyroidectomy attempted and underwent surgery for persistent hyperparathyroidism.

Discussion

The incidence of ITPA in the setting of primary hyperparathyroidism is poorly defined and ranges from 0.7–6.7% in part because of the lack of clear ITPA definition in some of the studies.14, 15, 16 Although mostly described in case reports and case series, Goodman et al16 recently reported that ITPA accounted for 0.7% of parathyroid adenomas in a large cohort. In their study, ITPAs were defined as being within the thyroid gland and another 1.2% were closely adherent or partially within the

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