Functional insignificance of microscopic parathyroid hyperplasia
Badder, E.M.; Graham, W.P.; Harrison, T.S.
Surgery Gynecology and Obstetrics 145(6): 863-868
1977
ISSN/ISBN: 0039-6087 PMID: 929358 Document Number: 121528
Recognition of the frequent disparity between the gross and histologic features of the parathyroid glands stimulated a review of recent surgically treated patients with hyperparathyroidism. Forty-three patients underwent at least 1 exploration of the neck for hyperparathyroidism in this interval. A surgical diagnosis of adenoma was made when one enlarged and at least one, preferably 3, normal or small parathyroid glands were identified and a biopsy was done. Among the 25 patients with macroscopic adenoma, the specimen of the normal sized glands appeared microscopically similar to the enlarged gland in 17 patients. Only 5 of 33 patients with histologic features of hyperplasia underwent subtotal parathyroidectomy, excision of 3 1/2 glands. Patients with histologic hyperplasia had a resection determined by surgical selection of the enlarged glands. Macroscopic, surgically recognized hyperplasia was present in 16 patients. Microscopic hyperplasia in this series was present in 33 patients. The 2 early recurrences found in this subgroup of microscopic hyperplasia were associated with a change in the pathologic diagnosis between frozen and permanent microscopic section. The results with hyperplasia of the parathyroid glands suggest that the selective excision of all enlarged glands with identification of the remaining glands by biopsy is reasonable and appropriate. Subtotal, 3 1/2 glands, parathyroidectomy is reserved for those patients with 4 enlarged glands.