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

ABSTRACT

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.