Location of Abnormal Parathyroid Glands: Lessons from 810 Parathyroidectomies

Abstract Introduction Primary hyperparathyroidism (pHPT) is commonly treated with targeted parathyroidectomy (PTX) guided by preoperative imaging and intraoperative parathormone monitoring (IPM). Despite advanced imaging techniques, failure of parathyroid localization still occurs. This study determines the anatomical distribution of single abnormal parathyroid glands, which may help direct the surgeon in PTX when preoperative localization is unsuccessful. Methods A retrospective review of prospectively collected data of 810 patients with pHPT who underwent initial PTX at a tertiary medical center was performed. All patients had biochemically confirmed pHPT and single gland disease. Abnormal parathyroid gland localization was determined at time of operation, correlated with operative and pathology reports, and confirmed by operative success defined as eucalcemia for > 6 months after PTX. Patients with MEN, secondary, tertiary or familial hyperparathyroidism, multiglandular disease, parathyroid cancer and ectopic glands were excluded. Data were analyzed by Chi-squared and Z-test analyses. Results Among 810 patients who underwent PTX for pHPT, single abnormal parathyroid glands were unequally distributed among the 4 eutopic locations (left superior, 15.7%; left inferior, 31.3%; right superior, 15.8%; right inferior, 37.2%; p