Letter to Editor: A Review of Parathyroid Surgery for Primary Hyperparathyroidism from the United Kingdom Registry of Endocrine and Thyroid Surgery

Abstract

Dear Sir, We read with interest the article ‘‘A Review of Parathyroid Surgery for Primary Hyperparathyroidism from the United Kingdom Registry of Endocrine and Thyroid Surgery’’ by Ishi et al. [1]. We congratulate the authors on their effort to contribute to the existing literature on parathyroid surgery with their study which is probably the largest registry of 21,738 cases of Primary Hyperparathyroidism and providing an insight to parathyroid surgery with an emphasis on the use of two adjuncts Intraoperative nerve monitoring and Intraoperative parathyroid hormone measurements. We agree with the authors that due to the diversity of parathyroid surgical practice which may be followed by general surgeons, Otolaryngologists, oral and maxilla facial surgeons, Endocrine surgeons, and Transplant and vascular surgeons, the term targeted parathyroidectomy encompasses various diverse surgical techniques the surgeon may perform depending on the nature of surgical training with available surgical adjuncts. We firmly believe that even with significant missing data and flaws in data collection as mentioned by the authors, such a study with great numbers adds value to the existing literature on parathyroid surgery. Bilateral neck exploration remains the workhorse of surgeons with limited resources and in the developing world, a bilateral neck exploration is still a valid option. We have a few queries which may interest future readers. The study aimed to record the efficiency and safety of targeted and bilateral neck exploration for primary hyperparathyroidism with or without surgical adjuncts. Can authors reliably record the efficiency only with hypocalcemia as a marker of biochemical cure and no available postoperative PTH levels? Regarding adjuncts in parathyroid surgery there are many adjuncts available such as Intraoperative Parathyroid Hormone measurement, Intraoperative nerve monitoring, Methylene blue, radio-guided parathyroidectomy, Surgeon performed the ultrasound, Indocyanine green, bilateral jugular venous sampling, and FNA PTH [2]. Do the authors feel the necessity to include these adjuncts in the database as these are slowly and steadily favored used by surgeons for the identification of parathyroid glands? Finally, safety and complications vary between surgical procedures performed by the consultant and trainees. Do the authors feel this issue would have contributed to a change in results if available and analyzed? Thanks for your comment on these issues.