ArticleAnnals of surgery2015
Management of the Parathyroid Glands During Preventive Thyroidectomy in Patients With Multiple Endocrine Neoplasia Type 2.
Article in Annals of surgery, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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18 citing papers in PubMed, 1 synthesis or guideline pooled it, 53 citations in OpenAlex.
- Parathyroid Allotransplantation: A Systematic Review.Medical sciences (Basel, Switzerland) · 2022Pooled it
- Article
- Parathyroid autotransplantation during thyroidectomy among the European Society of Endocrine Surgeons: we still do not agree.Updates in surgery · 2026Article
- Article
- Parathyroid autotransplantation: a phase-based framework for surgical decision-making.Frontiers in endocrinology · 2026Review
- MEN2: surgical precision in the era of precision medicine.Endocrine-related cancer · 2025Review
- An Analysis of Primary Hyperparathyroidism in Individuals Diagnosed with Multiple Endocrine Neoplasia Type 2.Diseases (Basel, Switzerland) · 2025Review
- Primary Hyperparathyroidism in MEN2 Syndromes.Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer · 2025Review
- Article
- Prophylactic and Early Thyroidectomy inCancers · 2022Article
- Hereditary medullary thyroid carcinoma syndromes: experience from western India.Familial cancer · 2021Article
- Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy.Journal of clinical medicine · 2021Review
- Parathyroid autotransplantation in thyroid surgery.Langenbeck's archives of surgery · 2018Review
- The PGRIS and parathyroid splinting concepts for the analysis and prognosis of protracted hypoparathyroidism.Gland surgery · 2017Article
- The use of ICG enhanced fluorescence for the evaluation of parathyroid gland preservation.Gland surgery · 2017Review
- Multiple Endocrine Neoplasia and Hyperparathyroid-Jaw Tumor Syndromes: Clinical Features, Genetics, and Surveillance Recommendations in Childhood.Clinical cancer research : an official journal of the American Association for Cancer Research · 2017Review
- Failure of fragmented parathyroid gland autotransplantation to prevent permanent hypoparathyroidism after total thyroidectomy.Langenbeck's archives of surgery · 2017Article
- Review
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8 authors at 4 institutions in 1 country.
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Abstract
objectivesPatients with multiple endocrine neoplasia type 2 (MEN2) have mutations in the RET protooncogene and virtually all of them will develop medullary thyroid carcinoma. Family members identified by genetic testing are candidates for preventive thyroidectomy. Management of the parathyroids during thyroidectomy is controversial. Some experts advocate total parathyroidectomy with autotransplantation, whereas others recommend preserving the parathyroids in situ.
methodsBetween 1993 and 2000, we performed preventive thyroidectomies on 50 patients with MEN2A (group A). All patients had a central neck dissection (CND) combined with total parathyroidectomy and autotransplantation of parathyroid slivers to the nondominant forearm or to the neck. Between 2003 and the present, we performed 102 preventive thyroidectomies attempting to preserve the parathyroid glands in situ with an intact vascular pedicle (group B). Individual parathyroids were autotransplanted only if they appeared nonviable or could not be preserved intact. Central neck dissection was done only if the serum calcitonin was greater than 40 pg/mL.
resultsPermanent hypoparathyroidism occurred in 3 (6%) of 50 patients in group A, compared with 1 (1%) of 102 patients in group B (P = 0.1). After total thyroidectomy, no patient in either group developed permanent recurrent laryngeal nerve injury or hyperparathyroidism. Immediate postoperative serum calcitonin levels were in the normal range (<5 pg/mL) in 100 of 102 patients in group B. No patients in either group have died. Oncologic follow-up of patients in group B is in progress.
conclusionsIn patients with MEN2A treated by preventive total thyroidectomy routine total parathyroidectomy with autotransplantation and CND gives excellent long-term results. However, preservation of the parathyroids in situ during preventive thyroidectomy combined with selective CND based on preoperative basal serum calcitonin levels is an effective and safe alternative that results in a very low incidence of hypoparathyroidism.
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