- Krouse RS, McCarty T, Weiss LM, et al (City of Hope Natl Med Ctr, Duarte, Calif)
Postoperative Suppressive Therapy for Thyroid Adenomas
Am Surg 66: 751-755, 2000
The benefits of postoperative suppressive therapy in 76 patients were analyzed in retrospective manner.
Conclusion : Postoperative treatment has no apparent benefit in reducing the risk of recurrent thyroid nodules.
R. A. Otto agrees with the authors that well designed prospective multicenter study should be conducted to address this question to resolve controversy.
- Irvin GL III, Molinari AS, Carneiro DM, et al (Univ of Miami/Jackson Mem and Veterans Affairs Med Ctrs, Fla)
Parathyroidectomy: New Criteria for Evaluating Outcome
Am Surg 65: 1186-1189, 1999
Background : Subjective improvement after parathyroidectomy has been established, but the biochemical criteria require updating in view of changes in the quantitative methods of measuring PTH and normal reference ranges of serum calcium.
271 patients with primary hyperparathyroidism studied over 6.3 years had not undergone parathyroidectomy, had had no operative failure and recorded calcium and iPTH levels at the last follow-up visit. The reference value for hypercalcemia was 11 mg/dL or higher; serum iPTH levels.
Results : Serum calcium levels were less than 10.6 mg/dL throughout follow-up of 257 patients, but 15% of these had increased iPTH levels.
Conclusion : If the level is less than 10.6 mg/dL there is no need to measure PTH; if it is 10.6 mg/dL there is no need to measure PTH, if it is 10.6 mg/dL or higher, iPTH should be assessed.
Normocalcemic patients who have elevated iPTH values rarely require surgery deleterious effects on bone mineral composition and renal function may occur in patients whose calcium levels have remained below 11.5 mg/dL for an extended period.
According to R. A. Otto, questions still remain as to the ideal treatment of patients with return of persistently elevated iPTH and normal serum calcium levels, the role of sequential multigland disease, and a variety of other pathophysiologic factors resulting in hyperparathyroidism.
- Kriskovich MD, Holman JM, Haller JR (Univ of Utah, Salt Lake City)
Calciphylaxis: Is There a Role for Parathyroidectomy?
Laryngoscope 110: 603-607, 2000
Calciphylaxis is a rare but potentially fatal condition, most often seen in patients with chronic renal failure.
The effects of parathyroidectomy in the treatment of calciphylaxis were reviewed.
Conclusion : Parathyroidectomy plays a significant role in the treatment and may give better results if performed earlier.