My Journey in Search of Parathyroid

The history of parathyroid glands — the small glands of 40 to 50 mg, — began in 1849 when Sir Richard Owen, Professor and Conservator of the Museum at the Royal College of Surgeons of England, discovered, while doing an autopsy on an Indian rhinoceros which had died after a scuffle with an elephant, “a small, compact, yellow glandular body attached to the thyroid at the point where the veins emerge”. From 1975 to the end of 2014 were operated on at the University of Turin, Third General Surgery, 1706 patients with HPT1, 1290 women and 416 males and 921 HPT2 and HPT3 patients, 437 women and 484 males. If a single gland disease was suspected and a focused approach is scheduled, preoperative imaging should be planned to help the surgeon to decide on which side the operation should begin. It is very important to remember that preoperative imaging should not be utilized to make the diagnosis or to decide if PTX has to be performed. Bilateral parathyroid exploration is important to exclude or identify MGD with high surgical cure rates (95–99%). The main indications are: patients with negative (nonlocalizing) preoperative imaging or when bilateral foci are detected, hereditary HPT, in females older than 60, because the percentage of hyperplasia is elevated, and concomitant thyroid disease requiring surgical resection, such as papillary thyroid cancer or goiter. In HPT2 and HPT3PTx effectively treats hyperparathyroidism-related hypercalcemia, hyperphosphatemia, bone pain, pruritus, and myopathy, but it does not seem to have a beneficial effect on calciphylaxis. There is also an improved long-term survival with surgery due to a reduction in cardiovascular disease, better blood pressure control, and decreased use of medications for hyperparathyroidism and hyperphosphatemia, an improved bone density and a lower risk of fractures PTx may improve nutritional status and humoral and cellular immunity. Additional studies need to be performed to see whether these patients would benefit more from PTx or from treatment with calcimimetic agents