Mediastinal Parathyroid Tumors

Bruce Lee Hall, Jeffrey Moley, Jeffrey Norton

Key Points

  • Understanding the embryologic origins of the superior and inferior parathyroids helps guide exploration, particularly when seeking undiscovered or ectopic glands.
  • Mediastinal parathyroids can be found in 11% to 22% of patients, but only 2% to 4% require sternotomy for removal. Most can be removed via a cervical approach.
  • Imaging studies are indicated for any question of mediastinal or intrathoracic parathyroids:99mTc-sestamibi and new 4-D computed tomography (CT) are most commonly employed.
  • Intraoperative parathyroid hormone monitoring is now a critical adjunct in the surgical treatment of parathyroid disease and can limit the extent of surgery.
  • Never discard normal parathyroid tissue, and always treat any parathyroid tissue discovered during reoperations as the patient’s only remaining tissue.
  • Hyperparathyroidism, considering all cases, is cured by surgery 95% to 99% of the time, including 90% of reoperations and 95% of reoperations with successful localization.

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Last updated: January 5, 2021