Advanced Surgical Management of Hyperparathyroidism: Total Parathyroidectomy with Supraomohyoid Neck Dissection. Case Report
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Abstract
Hyperparathyroidism is an endocrine disorder characterized by excessive secretion of parathyroid hormone, leading to significant alterations in calcium and phosphorus metabolism. Although most cases correspond to single parathyroid adenomas, advanced and multiglandular forms continue to represent a diagnostic and therapeutic challenge, particularly when associated with a cervical mass and suspicion of regional involvement. We present the case of a 58-year-old male patient with a history of severe hypercalcemia, recurrent nephrolithiasis, bone pain, and progressive enlargement of the left cervical region. Laboratory studies revealed markedly elevated parathyroid hormone levels, while cervical ultrasound, computed tomography, and sestamibi scintigraphy demonstrated a left parathyroid lesion associated with ipsilateral cervical lymphadenopathy. Due to the clinical and radiological findings suggestive of advanced disease, total parathyroidectomy associated with ipsilateral supraomohyoid neck dissection was performed. During the procedure, cervical neurovascular structures, including the recurrent laryngeal nerve, were identified and preserved. Postoperative evolution was favorable, with progressive decrease in serum calcium and parathyroid hormone levels, without major complications. Definitive histopathological analysis reported multiglandular parathyroid hyperplasia without evidence of malignant lymph node infiltration. This case highlights the importance of an individualized surgical approach in patients with advanced hyperparathyroidism associated with cervical mass, as well as the role of total parathyroidectomy and selective neck dissection in achieving adequate metabolic and locoregional control.
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References
I. Bilezikian, J. P., Bandeira, L., Khan, A., & Cusano, N. E. (2018). Hyperparathyroidism. The Lancet, 391(10116), 168–178.
https://doi.org/10.1016/S0140-6736(17)31430-7
II. Wilhelm, S. M., Wang, T. S., Ruan, D. T., Lee, J. A., Asa, S. L., Duh, Q. Y., Doherty, G. M., Herrera, M. F., Pasieka, J. L., Perrier, N. D., Silverberg, S. J., Solórzano, C. C., Sturgeon, C., Tublin, M. E., Udelsman, R., & Carty, S. E. (2016). The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surgery, 151(10), 959–968. https://doi.org/10.1001/jamasurg.2016.2310
III. Fraser, W. D. (2009). Hyperparathyroidism. The Lancet, 374(9684), 145–158.
https://doi.org/10.1016/S0140-6736(09)60507-9
IV. Udelsman, R., Åkerström, G., Biagini, C., Duh, Q. Y., Miccoli, P., Niederle, B., & Tonelli, F. (2014). The surgical management of asymptomatic primary hyperparathyroidism: Proceedings of the Fourth International Workshop. The Journal of Clinical Endocrinology & Metabolism, 99(10), 3595–3606. https://doi.org/10.1210/jc.2014-2000
V. Rodgers, S. E., Hunter, G. J., Hamberg, L. M., Schellingerhout, D., Doherty, D. B., Ayers, G. D., & Perrier, N. D. (2006). Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery, 140(6), 932–941. https://doi.org/10.1016/j.surg.2006.07.030
VI. Shane, E. (2018). Clinical review 122: Parathyroid carcinoma. The Journal of Clinical Endocrinology & Metabolism, 86(2), 485–493.
https://doi.org/10.1210/jcem.86.2.7207
VII. Hundahl, S. A., Fleming, I. D., Fremgen, A. M., & Menck, H. R. (1999). Two hundred eighty-six cases of parathyroid carcinoma treated in the U.S. between 1985–1995. Cancer, 86(3), 538–544.
https://doi.org/10.1002/(SICI)1097-0142(19990801)86:3<538::AID-CNCR26>3.0.CO;2-0
VIII. Ruda, J. M., Hollenbeak, C. S., & Stack, B. C. Jr. (2005). A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngology–Head and Neck Surgery, 132(3), 359–372.
https://doi.org/10.1016/j.otohns.2004.10.005
IX. Johnson, N. A., Tublin, M. E., & Ogilvie, J. B. (2007). Parathyroid imaging: Technique and role in the preoperative evaluation of primary hyperparathyroidism. American Journal of Roentgenology, 188(6), 1706–1715.
https://doi.org/10.2214/AJR.06.0938
X. Silverberg, S. J., Clarke, B. L., Peacock, M., Bandeira, F., Boutroy, S., Cusano, N. E., Dempster, D., Lewiecki, E. M., Liu, J. M., Minisola, S., Rejnmark, L., Silva, B. C., Walker, M. D., Bilezikian, J. P., & Potts, J. T. Jr. (2014). Current issues in the presentation of asymptomatic primary hyperparathyroidism. The Journal of Clinical Endocrinology & Metabolism, 99(10), 3580–3594.
https://doi.org/10.1210/jc.2014-1415
XI. Kunstman, J. W., Kirsch, J. D., Mahajan, A., & Udelsman, R. (2013). Clinical review: Parathyroid localization and implications for clinical management. The Journal of Clinical Endocrinology & Metabolism, 98(3), 902–912.
https://doi.org/10.1210/jc.2012-3168
XII. Lee, P. K., Jarosek, S. L., Virnig, B. A., Evasovich, M., & Tuttle, T. M. (2007). Trends in the surgical treatment of hyperparathyroidism in the United States from 1998 to 2008. Annals of Surgery, 246(5), 806–810. https://doi.org/10.1097/SLA.0b013e3180cc2f04
XIII. Mittendorf, E. A., Merlino, J. I., & McHenry, C. R. (2004). Parathyroid carcinoma. Journal of Surgical Oncology, 89(3), 136–142.