Hyperparathyroidism due to thoracic parathyroid glands

Introduction: The aim of this study was to review our experience in the management of hyperparathyroidism due to thoracic parathyroid glands. Patients and method: We retrospectively reviewed the medical records and surgical protocols of patients with primary or secondary hyperparathyroidism who required surgical resection of an abnormal parathyroid gland. Data on the following were gathered: demographic variables, whether previous parathyroidectomy had been performed or not, the results of imaging techniques, localization of the gland, the approach used, the number of glands identified, and postoperative complications. Results: Seven cases of thoracic parathyroid glands were identified representing 3% of the 239 parathyroidectomies (190 for primary hyperparathyroidism and 49 for secondary hyperparathyroidism) performed by our group. There were five men and two women aged between 36 and 67 years. Hyperparathyroidism was primary in four patients and secondary in three. In six patients with complete parathyroid identification, the thoracic parathyroid gland was supernumerary. All patients underwent two imaging techniques (CAT and Tc-MIBI/SPECT) with positive results. Three total median sternotomies, one partial sternotomy, two anterior left mediastinotomies and one left thoracotomy were performed. The abnormal glands were located in the anterior mediastinum (5), above the left border of the aortic arch (1) and in the aortopulmonary window (1). Conclusions: Hyperparathyroidism due to ectopic thoracic parathyroid gland is due to a supernumerary gland, is often diagnosed before the first surgical intervention, is most frequently located in the anterior mediastinum, and can be selectively treated, avoiding transsternal access. © 2003 Asociación Española de Cirujanos.