Advanced Ultrasound in Diagnosis and Therapy ›› 2021, Vol. 5 ›› Issue (3): 236-244.doi: 10.37015/AUDT.2021.200060
• Original Researchs • Previous Articles Next Articles
Ying Liu, MMa, Yang Zhou, MDa, Hong Zhou, BSa,*(), Yuanyuan Chen, MMb, Jian Wu, MDc, Juan Wang, BSa, Bin Wang, MMc, Changyu Chen, MMa, Ming Ye, MMa
Received:
2020-09-15
Revised:
2020-10-30
Accepted:
2020-11-08
Online:
2021-09-30
Published:
2021-08-31
Contact:
Hong Zhou, BS,
E-mail:664121529@qq.com
Ying Liu, MM, Yang Zhou, MD, Hong Zhou, BS, Yuanyuan Chen, MM, Jian Wu, MD, Juan Wang, BS, Bin Wang, MM, Changyu Chen, MM, Ming Ye, MM. Utilization of Ultrasound for Management of Surgical Intervention of Secondary Hyperparathyroidism and Prolonged Hypocalcemia Post-Parathyroidectomy. Advanced Ultrasound in Diagnosis and Therapy, 2021, 5(3): 236-244.
Figure 1
Sonographic images of PTGs in a 31 years old female patient in the hypo-vascular subgroup. There were five detectable PTGs, in which most of them (4/5) were hypo-vascular feature. (A). Longitudinal image of the gland in a right superior position (*), the gland was slightly heterogeneous, appearing to be partial hypoechoic and partial hyperechoic. The Doppler score Onoda was P1, C0; (B). Longitudinal image of the gland in the right inferior position (*), appearing to be hypoechoic with Doppler score Onoda P1, C0; (C). Longitudinal image of a supernumerary PTG in the right inferior position. This “newborn” echoic gland (*) was with Doppler score Onoda P1, C0; (D). Longitudinal image of a gland in a left superior position (*), appearing to be hypoechoic with the Doppler score Onoda P2, C0; (E). Longitudinal image of a gland in the left inferior position, appearing to be highly heterogeneous with partial hyperechoic (△) and partial hypoechoic. The Doppler score Onoda was P2, C2."
Figure 2
Sonographic images of PTGs of a 46 years old female patient in hyper-vascular subgroup. The total number of detectable PTGs was 5. Most of these PTGs (4/5) were hyper-vascular. (A) The longitudinal image showed the gland in right superior position (*), which was heterogeneously hyperechoic with the Doppler score Onoda was P1, C2; (B) The longitudinal image showed the gland in the right inferior position (*), which was medium heterogeneous, appearing to be partial hypoechoic and partial hyperechoic, The Doppler score Onoda was P2, C2;(C) The longitudinal image showed a supernumerary PTG gland (*) in the right inferior position, which shown to be homogeneous hypoechoic with Doppler score Onoda P2, C2; (D) The longitudinal image showed a gland (*) in the left superior position, which was slightly heterogeneous with Doppler score Onoda P1, C0; (E) The longitudinal image showed another gland (*) in the left inferior position, which was highly heterogeneous with annular calcification (white ★), cystic appearance (white circle) and Doppler score Onoda P1, C2."
Table 1
Patients with ultrasonic detective PTGs in surgical and medication group"
Items | Numbers of patients | Numbers of PTGs in 4 classical positions | Numbers of supernumerary PTGs |
---|---|---|---|
Surgical Group | 32 | 108 | 13 |
Patients with 1 US detectable PTG | 1 | 1 | 0 |
Patients with 2 US detectable PTGs | 4 | 8 | 0 |
Patients with 3 US detectable PTGs | 5 | 14 | 1 |
Patients with 4 US detectable PTGs | 16 | 61 | 3 |
Patients with 5 US detectable PTGs | 3 | 12 | 3 |
Patients with 6 US detectable PTGs | 3 | 12 | 6 |
Medication Group | 22 | 69 | 2 |
Patients with 1 US detectable PTG | 3 | 3 | |
Patients with 2 US detectable PTGs | 10 | 20 | 0 |
Patients with 3 US detectable PTGs | 4 | 11 | 1 |
Patients with 4 US detectable PTGs | 5 | 19 | 1 |
Patients with 5 US detectable PTGs | 0 | 0 | 0 |
Patients with 6 US detectable PTGs | 0 | 0 | 0 |
Table 2
Demographics and clinical features of patients in the surgical group and medication group"
Items | Surgical group | Medication group | P |
---|---|---|---|
Age (years) | 47.7 ± 12.8 | 46.8 ± 14.0 | n.s |
Patients | 32 | 22 | |
Sex | |||
Male | 20 | 7 | n.s |
Female | 12 | 15 | |
Duration of dialysis (years) a | 6.3 ± 2.6 | 5.4 ± 3.5 | < 0.05 |
BUN (μg/L) | 13.5 ± 7.4 | 16.4 ± 5.5 | n.s. |
Scr (mmol/L) | 529.1 ± 423.2 | 557.5 ± 307.3 | n.s |
Ca2+(mmol/L) a | 2.3 ± 0.5 | 2.5 ± 0.5 | < 0.01 |
P (mmol/L) a | 2.0 ± 0.3 | 1.7 ± 0.5 | < 0.05 |
Baseline PTH (pg/mL) a | 924.5±781.7 | 671.3 ± 509.6 | < 0.05 |
Ca2+*P a | 4.6 ± 2.2 | 3.1 ± 1.3 | < 0.05 |
Supernumerary PTGs locating posterior of the thyroid gland (num, %) a | 13 (10.7%) | 2, 2.8% | < 0.05 |
Average volume of PTGs (cm3) a | 1.0 ± 0.6 | 0.9 ± 0.7 | < 0.05 |
Total volume of PTGs (cm3) | 2.7 ± 1.9 | 2.3 ± 2.2 | n.s |
US detectable PTGs (num, %) | 120 | 71 | |
Homogeneous PTGs (num, %) | 32,26.6% | 13, 18.3% | n.s |
Hyper-echoic PTGs (num, %) | 4, 3.3% | 6,8.5% | |
Hypo-echoic PTGs (num, %) | 73, 60.8% | 47,66.2% | |
PTGs with calcification (num, %) | 7, 5.8% | 3,4.2% | |
PTGs with cystic degeneration (num, %) | 4, 3.4% | 2, 2.8% | |
Doppler score Onoda assement a | |||
Patients in hyper-vascular subgroup (num, %) | 18, 56.3% | 10, 45.4% | < 0.05 |
Patients in hypo-vascular subgroup (num, %) | 14, 43.7% | 12, 54.6% |
Table 3
Comparison between hyper- and hypo-vascular PTGs in the surgical group"
Surgical group (n = 32) | Numbers of excised PTGs | Average volume of excised PTGs of each patient (cm3) | Average pre-operative PTH (pmol/L) | Average pre-operative Ca2+ (mmol/L) | Patients with prolonged hypocalcemia (n = 15) | Average post-operative Ca2+ in 14 days (mmol/L) |
---|---|---|---|---|---|---|
Hyper-vascular subgroup (n = 18) | 69 | 3.7 ± 1.8 | 1219.5 ± 783.1a | 2.1 ± 0.5 a | 11(15.9%) a | 2.0 ± 0.7 a |
Hypo-vascular subgroup (n = 14) | 52 | 4.0 ± 2.1 | 893.3 ± 652.2 a | 2.4 ± 0.4 a | 2 (3.8%) a | 2.3 ± 0.6 a |
Figure 5
The average serum calcium (Ca2+) monitoring curves from post-operative day 1 to day 14 for patients in hyper-vascular and hypo-vascular groups. According to the pre-operative sonographies, there were: (i) 22 cases in hyper-vascular subgroup, shown in gray line, (ii) 10 cases in hypo-vascular subgroup, shown in black line. The average serum Ca levels of patients in hyper-vascular subgroup was significantly lower than that in hypo-vascular subgroup (2.0 ± 0.1 vs. 2.3 ± 0.1, p < 0.05)."
[1] |
Katoh N, Nakayama M, Shigematsu T, Yamamoto H, Sano K, Saito I, et al. Presence of sonographically detectable parathyroid glands can predict resistance to oral pulsed-dose calcitriol treatment of secondary hyperparathyroidism. Am J Kidney Dis 2000; 35:465-468.
pmid: 10692272 |
[2] |
Tominaga Y, Matsuoka S, Sato T, Uno N, Goto N, Katayama A, et al. Clinical features and hyperplastic patterns of parathyroid glands in hemodialysis patients with advanced secondary hyperparathyroidism refractory to maxacalcitol treatment and required parathyroidectomy. Ther Apher Dial 2007; 11:266-273.
doi: 10.1111/tap.2007.11.issue-4 |
[3] |
Young EW, Albert JM, Satayathum S, Goodkin DA, Pisoni RL, Akiba T, et al. Predictors and consequences of altered mineral metabolism: the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2005; 67:1179-1187.
pmid: 15698460 |
[4] | Onoda N, Kurihara S, Sakurai Y, Owada K, Osono E, Adachi H, et al. Evaluation of blood supply of the parathyroid glands in secondary hyperparathyroidism compared to histopathology. Nephrol Dial Transplant 2003; 18:34-37. |
[5] |
van der Plas WY, Engelsman AF, Özyilmaz A, van der Horst-Schrivers AN, Meijer K, van Dam GM, et al. Impact of the Introduction of calcimimetics on timing of parathyroidectomy in secondary and tertiary hyperparathyroidism. Ann Surg Oncol 2017; 24:15-22.
doi: 10.1245/s10434-016-5450-6 |
[6] |
Vulpio C, Bossola M, De Gaetano A, Maresca G, Di Stasio E, Spada PL, et al. Ultrasound patterns of parathyroid glands in chronic hemodialysis patients with secondary hyperparathyroidism. Am J Nephrol 2008; 28:589-597.
doi: 10.1159/000116875 pmid: 18277066 |
[7] | Fukagawa M, Nakanishi S, Kazama JJ. Basic and clinical aspects of parathyroid hyperplasia in chronic kidney disease. Kidney Int Suppl 2006; 102:S3-7. |
[8] |
Fukagawa M, Kitaoka M, Yi H, Fukuda N, Matsumoto T, Ogata E, et al. Serial evaluation of parathyroid size by ultrasonography is another useful marker for the long-term prognosis of calcitriol pulse therapy in chronic dialysis patient. Nephron 1994; 68:221-228.
pmid: 7830860 |
[9] | National Kidney Foundation. KDOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42:1-201. |
[10] |
Vulpio C, Bossola M. Parathyroid nodular hyperplasia and responsiveness to drug therapy in renal secondary hyperparathyroidism: an open question. Therapeutic Apheresis and Dialysis 2018; 22:11-21.
doi: 10.1111/1744-9987.12604 pmid: 28980761 |
[11] | Latus J, Roesel M, Fritz P, Braun N, Ulmer C, Steurer W, et al. Incidence of and risk factors for hungry bone syndrome in 84 patients with secondary hyperparathyroidism. Int J Nephrol Renov Dis 2013; 6:131-137. |
[12] |
Goldfarb M, Gondek SS, Lim SM, Farra JC, Nose V, Lew JI. Postoperative hungry bone syndrome in patients with secondary hyperparathyroidism of renal origin. World J Surg 2012; 36:1314-1319.
doi: 10.1007/s00268-012-1560-x pmid: 22399154 |
[13] |
Fang L, Tang B, Hou D, Meng M, Xiong M, Yang J. Relationship between parathyroid mass and parathyroid hormone level in hemodialysis patients with secondary hyperparathyroidism. BMC Nephrol 2015; 16:82.
doi: 10.1186/s12882-015-0077-6 pmid: 26058796 |
[14] |
Madorin C, Owen RP, Fraser WD, Pellitteri PK, Radbill B, Rinaldo A, et al. The surgical management of renal hyper-parathyroidism. Eur Arch Otorhinolaryngol 2012; 269:1565-1576.
doi: 10.1007/s00405-011-1833-2 |
[15] |
Schneider R, Bartsch DK. Role of surgery in the treatment of renal secondary hyperparathyroidism. Br J Surg 2015; 102:289-290.
doi: 10.1002/bjs.9661 pmid: 25359005 |
[16] |
Ho LY, Wong PN, Sin HK, Wong YY, Lo KC, Chan SF, et al. Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism. BMC Nephrol 2017; 18:12.
doi: 10.1186/s12882-016-0421-5 pmid: 28073343 |
[17] |
Goldsmith D, Covic A, Vervloet M, Cozzolino M, Nistor I. Should patients with CKD stage 5D and biochemical evidence of secondary hyperparathyroidism be prescribed calcimimetic therapy? an era-edta position statement. Nephrol Dial Transplant 2015; 30:698-700.
doi: 10.1093/ndt/gfv050 |
[18] |
Komaba H, Taniguchi M, Wada A, Iseki K, Tsubakihara Y, Fukagawa M. Parathyroidectomy and survival among Japanese hemodialysis patients with secondary hyperparathyroidism. Kidney Int 2015; 88:350-359.
doi: 10.1038/ki.2015.72 |
[19] |
Iwamoto N, Sato N, Nishida M, Hashimoto T, Kobayashi H, Yamasaki S, et al. Total parathyroidectomy improves survival of hemodialysis patients with secondary hyperparathyroidism. J Nephrol 2012; 25:755-763.
doi: 10.5301/jn.5000056 |
[20] |
Andrade JS, Mangussi-Gomes JP, Rocha LA, Ohe MN, Rosano M, das Neves MC, et al. Localization of ectopic and supernumerary parathyroid glands in patients with secondary and tertiary hyperparathyroidism: surgical description and correlation with preoperative ultrasonography and Tc99m-Sestamibi scintigraphy. Braz J Otorhinolaryngol 2014; 80:29-34.
doi: 10.5935/1808-8694.20140008 |
[21] |
Alkhalili E, Tasci Y, Aksoy E, Aliyev S, Soundararajan S, Taskin E, et al. The utility of neck ultrasound and sestamibi scans in patients with secondary and tertiary hyperparathyroidism. World J Surg 2015; 39:701-705.
doi: 10.1007/s00268-014-2878-3 pmid: 25409841 |
[22] |
Wagner PK, Seesko HG, Rothmund M. Replantation of cryopreserved human parathyroid tissue. World J Surg 1991; 15:751-755.
pmid: 1767542 |
[23] |
Wang Q, Palnitkar S, Parfitt AM. The basal rate of cell proliferation in normal human parathyroid tissue: implications for the pathogenesis of hyperparathyroidism. Clin Endocrinol 1997; 46:343-349.
pmid: 9156045 |
[24] |
Takebayashi S, Matsui K, Onohara Y, Hidai H. Sonography for early diagnosis of enlarged parathyroid glands in patients with secondary hyperparathyroidism. AJR Am J Roentgenol 1987; 148:911-914.
doi: 10.2214/ajr.148.5.911 |
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