AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

Brendan C Stack Jr; Neil S Tolley; Twyla B Bartel; John P Bilezikian; Donald Bodenner; Pauline Camacho; Jeremy P D T Cox; Henning Dralle; James E Jackson; John C Morris 3rd; Lisa Ann Orloff; Fausto Palazzo; John A Ridge; David Scott-Coombes; David L Steward; David J Terris; Geoffrey Thompson; Gregory W Randolph

doi:10.1002/hed.25023

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

Head Neck. 2018 Aug;40(8):1617-1629. doi: 10.1002/hed.25023. Epub 2018 Aug 2.

Authors

Brendan C Stack Jr¹, Neil S Tolley², Twyla B Bartel³, John P Bilezikian⁴, Donald Bodenner⁵, Pauline Camacho⁶, Jeremy P D T Cox⁷, Henning Dralle⁸, James E Jackson⁹, John C Morris 3rd¹⁰, Lisa Ann Orloff¹¹, Fausto Palazzo², John A Ridge¹², David Scott-Coombes¹³, David L Steward¹⁴, David J Terris¹⁵, Geoffrey Thompson¹⁶, Gregory W Randolph¹⁷

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
² Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK.
³ Global Advanced Imaging, PLLC, Little Rock, Arkansas.
⁴ Department of Medicine, Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, New York.
⁵ Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
⁶ Department of Medicine, Division of Endocrinology, Loyola University, Chicago, Illinois.
⁷ Department of Metabolic Medicine, Imperial College Hospital, NHS Healthcare Trust, London, UK.
⁸ Sektion Endokrine Chirurgie, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinisches Zentrum, Germany.
⁹ Department of Imaging, Hammersmith Hospital, Imperial College NHS Healthcare Trust, London, UK.
¹⁰ Department of Medicine, Division of Endocrinology, Mayo Clinic, Rochester, Minnesota.
¹¹ Department of Otolaryngology - Head and Neck Surgery, Stanford University, Palo Alto, California.
¹² Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
¹³ Department of Surgery, Cardiff and Vale Hospitals, Wales, UK.
¹⁴ Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio.
¹⁵ Department of Otolaryngology - Head and Neck Surgery, Augusta University, Augusta, Georgia.
¹⁶ Department of Surgery, Mayo Clinic, Rochester, Minnesota.
¹⁷ Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts.

PMID: 30070413
DOI: 10.1002/hed.25023

Abstract

Background: Revision parathyroid is challenging due to possible diagnostic uncertainty as well as the technical challenges it can present.

Methods: A multidisciplinary panel of distinguished experts from the American Head and Neck Society (AHNS) Endocrine Section, the British Association of Endocrine and Thyroid Surgeons (BAETS), and other invited experts have reviewed this topic with the purpose of making recommendations based on current best evidence. The literature was also reviewed on May 12, 2017. PubMed (1946-2017), Cochrane SR (2005-2017), CT databases (1997-2017), and Web of Science (1945-2017) were searched with the following strategy: revision and reoperative parathyroidectomy to ensure completeness.

Results: Guideline recommendations were made in 3 domains: preoperative evaluation, surgical management, and alternatives to surgery. Eleven guideline recommendations are proposed.

Conclusion: Reoperative parathyroid surgery is best avoided if possible. Our literature search and subsequent recommendations found that these cases are best managed by experienced surgeons using precision preoperative localization, intraoperative parathyroid hormone (PTH), and the team approach.

Keywords: consensus; guidelines; parathyroid; reoperative; surgery.

Publication types

Consensus Development Conference
Practice Guideline

MeSH terms

Bone Density
Calcium / blood
Cholecalciferol / therapeutic use
Clinical Competence
Diagnosis, Differential
Hospitals, High-Volume
Humans
Hyperparathyroidism, Primary / diagnosis
Hyperparathyroidism, Primary / surgery*
Intraoperative Neurophysiological Monitoring
Medical History Taking
Parathyroid Glands / diagnostic imaging
Parathyroid Glands / surgery*
Parathyroidectomy*
Patient Selection
Postoperative Complications / prevention & control
Preoperative Care
Recurrence
Reoperation*
Societies, Medical
Vitamin D Deficiency / drug therapy
Vitamins / therapeutic use

Substances

Vitamins
Cholecalciferol
Calcium