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Transcervical Thymectomy: An Integral Part of Neck Exploration for Hyperparathyroidism

Transcervical Thymectomy: An Integral Part of Neck Exploration for Hyperparathyroidism Abstract • Thirty-two neck explorations for hyperparathyroidism were done in 18 months. The indication for transcervical thymectomy was a failure to locate either inferior gland. Six of eight patients had adenomatous or hyperplastic glands located within or adjacent to the thymus. One infrathymic lesion was a parathyroid carcinoma and the other was a functioning parathyroid cyst. The abnormal parathyroid gland was not visible in any of these six patients until the thymus had been removed. Had this step been omitted, a sternotomy would probably have been required. Two patients had bilateral normal parathyroid glands within or deep to the thymus. Unless some normal parathyroid tissue has been identified and preserved, the indiscriminate use of transcervical thymectomy could result in the inadvertent excision of both inferior glands and possible iatrogenic hypoparathyroidism. (Arch Surg 111:359-364, 1976) References 1. Crotti A: Diseases of the Thyroid, Parathyroid and Thymus , ed 3. Philadelphia, Lee & Febiger Publishers, pp 350-352, 1938. 2. Kurtay M, Crile G Jr: Aberrant parathyroid glands in relationship to the thymus . Am J Surg 117:705, 1969.Crossref 3. Cope O: Surgery of hyperparathyroidism: The occurrence of parathyroids in the mediastinum and the division of the operation into two stages . Ann Surg 114:706-727, 1941.Crossref 4. Boyle DE, Mason EE: Parathyroid crisis . J Iowa Med Soc 56:359-466, 1966. 5. Reiling RB, Cady B, Clerkin EP: Aberrant parathyroid adenoma within vagus nerve . Lahey Clin Bull 21:158-162, 1971. 6. Morris WD, Westbrook KC, Thompson BW, et al: Hyperparathyroidism: Surgical problems . Am J Surg 128:767-772, 1974.Crossref 7. Beazley RM, Costa J, Ketcham AS: Reoperative parathyroid surgery . Am J Surg 130:427-429, 1975.Crossref 8. Crile G Jr: Thymectomy through the neck . Surgery 59:213-215, 1966. 9. Papatestas AE, Genkins G, Kornfeld P, et al: Transcervical thymectomy in myasthenia gravis . Surg Gynecol Obstet 140:535-540, 1975. 10. Cady B: Neck exploration for hyperparathyroidism . Surg Clin North Am 53:301-306, 1973. 11. Alveryd A: Parathyroid glands in thyroid surgery . Acta Chir Scand ( (suppl) ) 389:9-36, 1968. 12. Herbst JW, Neff WR, Freeman JB: Hyperparathyroidism: Ectopic parathyroid glands. Am J Surg, to be published. 13. Friend CR: Re-exploration for parathyroid adenoma . Am J Surg 108:543-546, 1964.Crossref 14. Margolis IB, Wayne R, Organ CH: Parathyroid cysts: Functional and mediastinal . Surgery 77:462-466, 1975. 15. Schantz A, Castleman B: Parathyroid carcinoma: A study of 70 cases . Cancer 31:600-605, 1973.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Transcervical Thymectomy: An Integral Part of Neck Exploration for Hyperparathyroidism

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References (14)

Publisher
American Medical Association
Copyright
Copyright © 1976 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1976.01360220055009
Publisher site
See Article on Publisher Site

Abstract

Abstract • Thirty-two neck explorations for hyperparathyroidism were done in 18 months. The indication for transcervical thymectomy was a failure to locate either inferior gland. Six of eight patients had adenomatous or hyperplastic glands located within or adjacent to the thymus. One infrathymic lesion was a parathyroid carcinoma and the other was a functioning parathyroid cyst. The abnormal parathyroid gland was not visible in any of these six patients until the thymus had been removed. Had this step been omitted, a sternotomy would probably have been required. Two patients had bilateral normal parathyroid glands within or deep to the thymus. Unless some normal parathyroid tissue has been identified and preserved, the indiscriminate use of transcervical thymectomy could result in the inadvertent excision of both inferior glands and possible iatrogenic hypoparathyroidism. (Arch Surg 111:359-364, 1976) References 1. Crotti A: Diseases of the Thyroid, Parathyroid and Thymus , ed 3. Philadelphia, Lee & Febiger Publishers, pp 350-352, 1938. 2. Kurtay M, Crile G Jr: Aberrant parathyroid glands in relationship to the thymus . Am J Surg 117:705, 1969.Crossref 3. Cope O: Surgery of hyperparathyroidism: The occurrence of parathyroids in the mediastinum and the division of the operation into two stages . Ann Surg 114:706-727, 1941.Crossref 4. Boyle DE, Mason EE: Parathyroid crisis . J Iowa Med Soc 56:359-466, 1966. 5. Reiling RB, Cady B, Clerkin EP: Aberrant parathyroid adenoma within vagus nerve . Lahey Clin Bull 21:158-162, 1971. 6. Morris WD, Westbrook KC, Thompson BW, et al: Hyperparathyroidism: Surgical problems . Am J Surg 128:767-772, 1974.Crossref 7. Beazley RM, Costa J, Ketcham AS: Reoperative parathyroid surgery . Am J Surg 130:427-429, 1975.Crossref 8. Crile G Jr: Thymectomy through the neck . Surgery 59:213-215, 1966. 9. Papatestas AE, Genkins G, Kornfeld P, et al: Transcervical thymectomy in myasthenia gravis . Surg Gynecol Obstet 140:535-540, 1975. 10. Cady B: Neck exploration for hyperparathyroidism . Surg Clin North Am 53:301-306, 1973. 11. Alveryd A: Parathyroid glands in thyroid surgery . Acta Chir Scand ( (suppl) ) 389:9-36, 1968. 12. Herbst JW, Neff WR, Freeman JB: Hyperparathyroidism: Ectopic parathyroid glands. Am J Surg, to be published. 13. Friend CR: Re-exploration for parathyroid adenoma . Am J Surg 108:543-546, 1964.Crossref 14. Margolis IB, Wayne R, Organ CH: Parathyroid cysts: Functional and mediastinal . Surgery 77:462-466, 1975. 15. Schantz A, Castleman B: Parathyroid carcinoma: A study of 70 cases . Cancer 31:600-605, 1973.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Apr 1, 1976

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