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Thyroid-stimulating antibodies A family of IgG immunoglobulins bind with TSH receptor sites (TRAbs) and activate TSH receptors on the follicular cell ) are 4 membrane. They have a more protracted action than TSH (16–24 versus 1.5–3 hours) and are responsible ...

Treatment When medullary carcinoma is diagnosed, staging of the neck and chest should be performed. For patients with disease confined to the thyroid, total thyroidectomy is recommended to remove all C cells with elective dissection of the central neck nodes. ...

Undifferentiated (anaplastic) carcinoma This is one of the most aggressive malignancies in humans. Thankfully it is rare. It may develop de novo or present as dedif - ferentiation of a papillary or poorly di ff erentiated carcinoma. The disease is characterise...

ANATOMY OF THE PARATHYROID GLANDS The developmental embryology and surgical anatomy of the parathyroid glands are intimately linked, and knowledge of both is essential for successful surgical treatment of parathy roid disease. The parathyroid glands, of whic...

CALCIUM AND PARATHYROID HORMONE REGULATION The parathyroid glands play a central role in the regulation of serum calcium levels through the production of the active 84-amino-acid peptide, parathyroid hormone (PTH). PTH is secreted in response to low serum ca...

Calciphylaxis Calciphylaxis (calcific uraemic arteriolopathy) is a syndrome of disseminated calcification resulting in both vascular calci fication and skin necrosis. It accounts for approximately 4% of patients undergoing surgical intervention for secondary hy...

Diagnosis PHPT is a biochemical diagnosis. Only when the disease has been confirmed biochemically should localisation studies be undertaken. Positive imaging does not confirm the diagnosis and negative findings cannot rule it out. PHPT is defined as an elevated t...

FURTHER READING Agarwal A, Mishra AK, Lombardi CP , Ra ff aelli M. Applied embryology of the thyroid and parathyroid glands. In: G.W . Randolph surgery of the thyroid and parathyroid glands . Philadelphia, PA: Saunders, 2013: 15–24. Barczyn ´ski M, Bränström ...

Familial syndromes Familial hyperparathyroidism can be part of a well-recognised endocrine disorder, but it may also occur in isolation in a non-syndromic form. PHPT occurs as a central facet in multiple MEN type 1, type 4, type 2A, HPT-JT , autosomal dominant...

Hypercalcaemic crisis: presentation and management Hypercalcaemia is documented in 0.5% of the general population and in up to 5% of hospitalised patients. The vast majority are asymptomatic with a mild to moderate elevation of serum calcium (<3 /uni00A0 mm...

INTRODUCTION The parathyroid glands were first described by Sir Richard Owen in a neck dissection of an Indian rhinoceros at the London Zoological Gardens in 1850. Credit for recognition of the ‘glandulae parathyreoidae’ goes, however, to Sandström, who publis...

Learning objectives To understand: The anatomy of the parathyroid glands • The physiology of calcium regulation • The underlying causes of hypercalcaemia and appropriate • emergency management The aetiology, presentation, investigation and • management of prim...

Localisation studies Historically , preoperative localisation studies for PHPT were considered less important than identifying an experienced surgeon. However, with a shift away from the traditional four- gland (cervical neck) exploration to more minimally in...

Management Renal transplantation remains the only definite treatment for secondary hyperparathyroidism. Other therapies are a bridge to this or aim to provide symptom relief. Standard manage - ment includes replacement of calcium and vitamin D and the reductio...

PARATHYROID CARCINOMA Parathyroid carcinoma is a rare malignancy occurring in approximately 1% of cases of PHPT , with an estimated prevalence of 0.005% of all cancers. While the aetiology remains unclear, recent advances in molecular biology suggest that ...

PERSISTENT HYPERPARATHYROIDISM Persistent hyperparathyroidism is defined as an elevated calcium within 6 weeks of surgical intervention. For all parathyroid operations (minimally invasive parathyroidectomy [MIP] and bilateral exploration) the rate of persiste...

PRIMARY HYPERPARATHYROIDISM The early descriptions of patients with PHPT were dominated by those with osteitis fibrosa cystica. Brown tumours of the long bones and associated subperiosteal bone reabsorption, distal tapering of the clavicles and the classical...

Pathology The underlying aetiology of PHPT is usually a solitary parathyroid adenoma; however, in a small number of patients (2–4%) there are double adenomas. It may occur in a sporadic fashion or it can be familial (approximately 10%) (MEN type 1, type 4, t...