Parathyroid Ectopia-Development of a Surgical Algorithm

Objective: Study the incidence of ectopic parathyroid adenomata from a single surgical series and devise a surgical algorithm from the results to follow when an adenoma cannot initially be located. Method: Retrospective review of a prospectively collected senior author’s (RJAE) database of 357 patients who underwent parathyroidectomy between June 2001 and February 2008. From the database, an ordered surgical protocol has been developed for the location of both ectopic superior and inferior parathyroid adenomata in order of incidence. Results: Parathyroid ectopia occurs in approximately 10% of cases of hyperparathyroidism. It is more common in superior than inferior parathyroid glands. The most common superior location is the left retroesophageal position, and the most common inferior location is within the left thymic remnant. Conclusion: Prospective data collection and subsequent analysis can lead to the development of a systematic surgical protocol to aid the location of ectopic enlarged parathyroid glands in the surgical management of hyperparathyroidism.