Parathyroid surgery in the multiple endocrine neoplasia type I syndrome: Choice of surgical procedure

Abstract

Abstract Thirty‐nine patients with hyperparathyroidism (HPT) in association with the multiple endocrine neoplasia type I (MEN‐I) syndrome underwent parathyroid surgery from 1961 to 1985. Twenty‐one patients underwent resection of 1–21/2 glands, 6 had 3–31/2 glands removed, and 18 (9 of whom had previously been subjected to parathyroid surgery) underwent total parathyroidectomy with autotransplantation to the forearm. Resection of 1–21/2 glands resulted in persistent or recurrent HPT in 18 (88%) of the 21 cases. Two (33%) of the 6 patients who underwent 3–31/2‐gland resection had recurrent disease. After total parathyroidectomy with autotransplantation to the forearm, no patient had persistent or recurrent HPT. Five (26%) of 18 patients had permanent hypocalcemia requiring supplemental therapy. After a change in the operative technique, however, only 1 of 10 was permanently hypocalcemic. It is concluded that primary HPT in the MEN‐I syndrome always should be treated with radical surgery. Total parathyroidectomy with autotransplantation seems more favorable than 3–31/2‐gland resection owing to the absence of recurrent HPT in this material and the limited number of patients with long‐standing postoperative hypocalcemia, provided that an optimal technique for autotransplantation was performed .