Primary hyperparathyroidism due to mediastinal parathyroid lesions

Parathyroidectomy (PTX) is the treatment of choice, with a cure rate of 95–98% in expert centres [1, 2]. Commonly inadequate resection is caused by ectopic glands. Mostly they are found in the superior mediastinum among the thymus gland and can be excised by a collar incision [3].
A mediastinal parathyroid (MP) is determined as a gland found completely below the level of the clavicle. Approximately 15–20% of abnormal parathyroid glands are found in the mediastinum. Ectopic inferior parathyroids are frequently located in the anterior mediastinum, usually in the thymus gland, while superior parathyroids are found in the posterosuperior mediastinum. Less commonly they may be located in the aortopulmonary window and rarely in the pericardium [4–6].
We report 4 patients operated by upper median sternotomy for primary hyperparathyroidism (PHP) due to ectopic mediastinal lesions.
Between the years 1983 and 2018 a total of 1019 patients underwent surgery for PHP at our institution. Among this group of patients 66 (6.5%) were operated for ectopic lesions localized in the mediastinum. In 62 (94%) patients the ectopic lesions were excised via cervicotomy, 4 of whom required an upper median sternotomy approach. There were 2 women and 2 men, aged 22–72, mean 52.5 years. The diagnostic and surgical approaches used for our 4 patients are shown in Table I.
All patients diagnosed for PHP were referred to our department for further treatment, from other centres. Apart from one woman admitted for threatened hypercalcaemic crisis (1.63 mmol/l), the reminder had scintigraphy Tc99-MIBI/SPECT performed.
Patient 1: This was a 72-year-old woman who complained of general weakness, consciousness disorders, and bone pain. A ultrasonography (USG) of the neck revealed multinodular thyroid gland and probably enlarged left upper parathyroid gland (11 × 7 mm). During the operation both upper parathyroid glands were removed. No lower parathyroid gland was seen and ionized parathormone level (iPTH) did not decrease; near total thyroidectomy was performed. After the operation her condition worsened and on the 7th postoperative day helical computed tomography (CT) scanning was performed. The examination revealed a mass 30 × 20 × 20 mm in the aorto-pulmonary window. Moreover, pathologic fracture Th8-Th9 was seen. She was re-operated the next day, and the lesion was excised. The post-operative period was complicated with bilateral pneumonia and serious...


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