RESUMO
OBJECTIVE: Tertiary hyperparathyroidism, an autonomous hyperproduction of parathyroid hormone (PTH), has a challenge in its treatment. This study asked whether the intraoperative PTH and calcium drop can confirm the resection of all parathyroid tissues. STUDY DESIGN: Case series with planned data collection. SETTING: Tertiary referral medical center. SUBJECTS AND METHODS: The study assessed patients with tertiary hyperparathyroidism who were treated at the Hospital of the State University of Campinas from 2007 to 2015. All patients underwent total parathyroidectomy with autotransplantation of parathyroid fragments. PTH and calcium were collected during the preoperative period; at 10, 20, and 240 minutes after resection of the glands; and at 1 year after the procedure. Data were analyzed by analysis of variance and logistic regression analysis with statistical values of P < .05. RESULTS: Thirty-five patients were assessed: 17 women (48.57%) and 18 men (51.43%). The percentage of PTH drop was statistically significant at all times, unlike the calcium analysis, but only PTH collected at 20 minutes was able to confirm the removal of all parathyroid tissues (P = .029). Based on the receiver operating characteristic curve, the 71.2% drop obtained high sensitivity and specificity (P = .028). CONCLUSIONS: Treatment success can be predicted by analyzing the decrease of intraoperative PTH and not by calcium. The 71.2% PTH drop at 20 minutes after parathyroidectomy had high sensitivity and specificity to predict surgical cure.
Assuntos
Cálcio/sangue , Hiperparatireoidismo/cirurgia , Hormônio Paratireóideo/sangue , Paratireoidectomia , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Hiperparatireoidismo/sangue , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Valor Preditivo dos Testes , Curva ROC , Resultado do TratamentoRESUMO
ABSTRACT Objective: To define serum parathyroid hormone (PTH) reference values in carefully selected subjects following the recommended pre-analytical guidelines. Subjects and methods: First, 676 adults who would be submitted to thyroidectomy were evaluated. Patients using interfering medications or with malabsorption syndrome, hypomagnesemia, hyper- or hypophosphatemia, hypo- or hypercalcemia, 25-hydroxyvitamin D < 30 ng/dL, estimated glomerular filtration rate < 60 mL/min/1.73 m2, urinary calcium/creatinine ratio ≥ 0.25, thyroid dysfunction, parathyroid adenoma detected during surgery were excluded. The sample consisted of 312 subjects. Results: The median, minimum, maximum, and 2.5th and 97.5th percentiles of the PTH values obtained were 30, 7.2, 78, 10.1, and 52 pg/mL, respectively. Thus, the reference range was 10 to 52 pg/mL. PTH > 65 pg/mL, the upper limit of normal according to the manufacturer of the kit, was observed in only one subject (0.3%). Considering the upper limit proposed by the kit's manufacturer, 1/6 hypercalcemic patients and 4/8 normocalcemic patients with PHPT had normal PTH. Using the upper limit established in this study, only one normocalcemic patient had normal PTH. Thus, the sensitivity of PTH in detecting asymptomatic primary hyperparathyroidism (PHPT) using the values recommended by the kit and established in this study was 64% and 93%, respectively (50% versus 87.5% for normocalcemic PHPT). Conclusion: The upper reference limit of PTH obtained for a rigorously selected sample was 20% lower than that provided by the assay, which increased its sensitivity in detecting PHPT.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Hormônio Paratireóideo/sangue , Nódulo da Glândula Tireoide/sangue , Hiperparatireoidismo/diagnóstico , Hormônio Paratireóideo/normas , Valores de Referência , Tireoidectomia , Vitamina D/análogos & derivados , Vitamina D/sangue , Brasil , Cálcio/urina , Estudos Prospectivos , Paratireoidectomia , Sensibilidade e Especificidade , Pré-Menopausa/sangue , Pós-Menopausa/sangue , Hiperparatireoidismo/sangueRESUMO
OBJECTIVE: To define serum parathyroid hormone (PTH) reference values in carefully selected subjects following the recommended pre-analytical guidelines. SUBJECTS AND METHODS: First, 676 adults who would be submitted to thyroidectomy were evaluated. Patients using interfering medications or with malabsorption syndrome, hypomagnesemia, hyper- or hypophosphatemia, hypo- or hypercalcemia, 25-hydroxyvitamin D < 30 ng/dL, estimated glomerular filtration rate < 60 mL/min/1.73 m2, urinary calcium/creatinine ratio ≥ 0.25, thyroid dysfunction, parathyroid adenoma detected during surgery were excluded. The sample consisted of 312 subjects. RESULTS: The median, minimum, maximum, and 2.5th and 97.5th percentiles of the PTH values obtained were 30, 7.2, 78, 10.1, and 52 pg/mL, respectively. Thus, the reference range was 10 to 52 pg/mL. PTH > 65 pg/mL, the upper limit of normal according to the manufacturer of the kit, was observed in only one subject (0.3%). Considering the upper limit proposed by the kit's manufacturer, 1/6 hypercalcemic patients and 4/8 normocalcemic patients with PHPT had normal PTH. Using the upper limit established in this study, only one normocalcemic patient had normal PTH. Thus, the sensitivity of PTH in detecting asymptomatic primary hyperparathyroidism (PHPT) using the values recommended by the kit and established in this study was 64% and 93%, respectively (50% versus 87.5% for normocalcemic PHPT). CONCLUSION: The upper reference limit of PTH obtained for a rigorously selected sample was 20% lower than that provided by the assay, which increased its sensitivity in detecting PHPT.
Assuntos
Hiperparatireoidismo/diagnóstico , Hormônio Paratireóideo/sangue , Nódulo da Glândula Tireoide/sangue , Adolescente , Adulto , Idoso , Brasil , Cálcio/urina , Feminino , Humanos , Hiperparatireoidismo/sangue , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/normas , Paratireoidectomia , Pós-Menopausa/sangue , Pré-Menopausa/sangue , Estudos Prospectivos , Valores de Referência , Sensibilidade e Especificidade , Tireoidectomia , Vitamina D/análogos & derivados , Vitamina D/sangue , Adulto JovemRESUMO
BACKGROUND: Secondary and tertiary hyperparathyroidism (SHPT and THPT), are complications of chronic kidney disease (CKD), characterized by high levels of serum parathormone, hyperphosphatemia or hypercalcemia, respectively. If diet and pharmacological therapies fail, clinical practice guidelines suggest parathyroidectomy (PTX). Some studies have described its effectiveness and safety, but these have not included Mexican population. OBJECTIVE: To describe long-term effectiveness of PTX in Mexican patients with SHPT or THPT. MATERIAL AND METHODS: Observational and retrospective study of patients treated with PTX between 1995 and 2014 in a third level hospital in Mexico City. The analyses included the follow-up of medical treatment and biochemical assessment every three months during the first year, and the last evaluation. Permutation and chi square tests were used. RESULTS: The study included 27 patients (14 women). The follow-up mean was 39 months; 61.5% had SHPT. All biochemical parameters, except magnesium, were reduced in the first year of follow-up. In the long term, SHPT was controlled in 80% using PTH under a 300 pg/mL criterion, and 90% in patients with THPT using calcium criterion. Persistent hypocalcemia was present in 11.5% of cases. CONCLUSION: Mexican patients with SHPT and THPT could be successfully treated with surgery with low risk of hypocalcemia.
INTRODUCCIÓN: el hiperparatiroidismo secundario (SHPT) y terciario (THPT) son complicaciones de la enfermedad renal crónica (ERC), caracterizadas por elevación de hormona paratiroidea, hiperfosfatemia o hipercalcemia. Si la terapia nutricional y farmacológica fallan, se sugiere la paratiroidectomía (PTX). Los estudios de cohorte que han descrito su efectividad no incluyen a la población mexicana. OBJETIVO: describir la efectividad a largo plazo de la PTX en pacientes mexicanos con SHPT y THPT. MATERIAL Y MÉTODOS: estudio observacional, retrospectivo de pacientes tratados con PTX entre 1995 y 2014 en un hospital de tercer nivel de la Ciudad de México. Se registraron la terapia médica, la evaluación bioquímica, cada tres meses durante un año, y la última evaluación registrada. Se utilizaron pruebas de permutación y de chi cuadrada. RESULTADOS: se incluyeron 27 pacientes (14 mujeres). El seguimiento promedio fue de 39 meses; 61.5% tuvieron SHPT. Los parámetros bioquímicos, salvo el magnesio, disminuyeron durante el primer año postquirúrgico. A largo plazo, el SHPT fue controlado en 80%, con el criterio de la PTH menor de 300 pg/mL, y el THPT en el 90% con el criterio de normocalcemia. La hipocalcemia permanente estuvo presente en 11.5% de los casos. CONCLUSIÓN: los pacientes mexicanos con SHPT y THPT pueden ser tratados exitosamente mediante cirugía con bajo riesgo de hipocalcemia.
Assuntos
Hiperparatireoidismo/cirurgia , Paratireoidectomia , Adulto , Distribuição de Qui-Quadrado , Feminino , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/tratamento farmacológico , Hiperparatireoidismo/etiologia , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/tratamento farmacológico , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Hipocalcemia/epidemiologia , Falência Renal Crônica/complicações , Masculino , México , Hormônio Paratireóideo/administração & dosagem , Hormônio Paratireóideo/sangue , Estudos RetrospectivosRESUMO
BACKGROUND: Roux-en-Y gastric bypass patients can experience changes in calcium metabolism and hyperparathyroidism secondary to vitamin D deficiency. AIM: To evaluate nutritional deficiencies related to the calcium metabolism of patients undergoing gastric bypass with a 10-year follow-up. METHOD: This is a longitudinal retrospective study of patients submitted to Roux-en-Y gastric bypass at a multidisciplinary clinic located in the Brazilian southeast region. The study investigated the results of the following biochemical tests: serum calcium, ionized calcium, vitamin D, and parathormone (PTH). The generalized estimating equations (GEE) determined the nutritional deficiencies using a significance level of 5%. RESULTS: Among the patients who finished the study (120 months), 82.86% (n=29) had vitamin D deficiency, and 41.94% (n=13) had high PTH. Postoperative time had a significant effect on PTH (p=0.0059). The percentages of patients with vitamin D, serum calcium, and ionized calcium deficiencies did not change significantly over time. CONCLUSION: One of the outcomes was vitamin D deficiency associated with secondary hyperparathyroidism. These findings reaffirm the importance of monitoring the bone metabolism of patients submitted to Roux-en-Y gastric bypass. HEADINGS: Calcium deficiency. Vitamin D deficiency. Secondary hyperparathyroidism.
Assuntos
Cálcio/sangue , Derivação Gástrica/efeitos adversos , Hiperparatireoidismo/etiologia , Desnutrição/etiologia , Hormônio Paratireóideo/sangue , Deficiência de Vitamina D/etiologia , Brasil/epidemiologia , Seguimentos , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/epidemiologia , Estudos Longitudinais , Desnutrição/sangue , Desnutrição/epidemiologia , Complicações Pós-Operatórias , Período Pós-Operatório , Prevalência , Estudos Retrospectivos , Fatores de Tempo , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologiaRESUMO
ABSTRACT Background : Roux-en-Y gastric bypass patients can experience changes in calcium metabolism and hyperparathyroidism secondary to vitamin D deficiency. Aim : To evaluate nutritional deficiencies related to the calcium metabolism of patients undergoing gastric bypass with a 10-year follow-up. Method : This is a longitudinal retrospective study of patients submitted to Roux-en-Y gastric bypass at a multidisciplinary clinic located in the Brazilian southeast region. The study investigated the results of the following biochemical tests: serum calcium, ionized calcium, vitamin D, and parathormone (PTH). The generalized estimating equations (GEE) determined the nutritional deficiencies using a significance level of 5%. Results : Among the patients who finished the study (120 months), 82.86% (n=29) had vitamin D deficiency, and 41.94% (n=13) had high PTH. Postoperative time had a significant effect on PTH (p=0.0059). The percentages of patients with vitamin D, serum calcium, and ionized calcium deficiencies did not change significantly over time. Conclusion : One of the outcomes was vitamin D deficiency associated with secondary hyperparathyroidism. These findings reaffirm the importance of monitoring the bone metabolism of patients submitted to Roux-en-Y gastric bypass. HEADINGS: Calcium deficiency. Vitamin D deficiency. Secondary hyperparathyroidism.
Resumo Racional: Pacientes submetidos ao bypass gástrico em Y-de-Roux, podem apresentar alterações do metabolismo do cálcio e hiperparatireoidismo secundário à deficiência de vitamina D. Objetivo: Avaliar as deficiências nutricionais relacionadas ao metabolismo do cálcio de pacientes submetidos à bypass gástrico em Y-de-Roux, com seguimento de 10 anos. Método: Um estudo retrospectivo longitudinal foi conduzido com pacientes submetidos à bypass gástrico em Y-de-Roux, em uma Clínica Multidisciplinar no Sudeste do Brasil. Investigou-se a frequência do acompanhamento médico e nutricional e os exames bioquímicos de cálcio sérico, cálcio iônico, vitamina D e paratormônio (PTH). Para a análise das deficiências nutricionais, foram utilizadas as Equações de Estimativas Generalizadas (EEG), com nível de significância de 5%. Resultados: Dos pacientes que permaneceram no estudo até o final (120 meses), 82,86% (29), apresentaram níveis de deficiência de vitamina D e 41,94% (13) apresentaram PTH elevado. O efeito do tempo foi significativo para o PTH (p=0,0059). Para a vitamina D, cálcio sérico e cálcio iônico, o percentual de deficiência manteve-se constante ao longo do tempo, sem diferença significativa entre os tempos. Conclusão: A deficiência de vitamina D, associada ao hiperparatireoidismo secundário, foi um desfecho encontrado. Tais achados reafirmam a importância do cuidado com o metabolismo ósseo, em pacientes submetidos à bypass gástrico em Y-de-Roux.
Assuntos
Humanos , Hormônio Paratireóideo/sangue , Deficiência de Vitamina D/etiologia , Derivação Gástrica/efeitos adversos , Cálcio/sangue , Desnutrição/etiologia , Hiperparatireoidismo/etiologia , Complicações Pós-Operatórias , Período Pós-Operatório , Fatores de Tempo , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/epidemiologia , Brasil/epidemiologia , Prevalência , Estudos Retrospectivos , Seguimentos , Estudos Longitudinais , Desnutrição/sangue , Desnutrição/epidemiologia , Hiperparatireoidismo/sangue , Hiperparatireoidismo/epidemiologiaRESUMO
OBJECTIVE: To establish the impact the chronic kidney disease stage has in the native vitamin D levels in patients not undergoing dialysis treatment. METHODS: A study performed in Manizales, Colombia, a city located 2,200 meters above sea level, without important stational variations. Patients with 18 years of age or more, with chronic kidney disease stages 2 to 5 and not undergoing dialysis treatment were recruited for this study. Demographic and anthropometric variations were evaluated as well as solar exposure, CKD etiology and laboratory variables related to bone and mineral diseases. For each CKD clinical stage, correlations were evaluated for vitamin D levels, laboratory results for bone and mineral diseases, solar exposure and ethnicity. RESULTS: Three hundred thirty-three patients were evaluated with a median age of 71 years, most of them mestizo (71%), 173 were women. The main CKD etiology was hypertensive nephropathy (32.2%). 21.1% of patients had normal vitamin D levels, 70.1% were within insufficient range and 8.8% were in deficit. A negative correlation was found between the levels of vitamin 25 (OH) D and the values for: creatinine, phosphorous, calcium x phosphorous product, PTH, 24 hours urine protein and BMI. A positive relationship was found for calcium and albumin. Positive significant statistical correlation was found for vitamin 25(OH) D levels and solar exposure for stages 3b and 4 of CKD. CONCLUSIONS: It is common to find low levels of vitamin 25(OH) D in patients with CKD; these can contribute to the appearance of secondary hyperparathyroidism. OBJETIVO: Establecer el impacto del estadio clínico en los niveles de vitamina D nativa en pacientes con enfermedad renal crónica (ERC) sin diálisis. MÉTODOS: Estudio realizado en Manizales, Colombia, una ciudad tropical ubicada a 2,200 metros de altura sobre el nivel del mar, sin variaciones estacionales importantes a lo largo del año. Se incluyeron pacientes mayores de 18 años, con enfermedad renal crónica estadio 2 a 5 sin tratamiento dialítico. En ellos se evaluaron variables demográficas, antropométricas, grado de exposición solar, etiología de la enfermedad, y variables de laboratorio relacionadas con desórdenes óseos y minerales. Para cada estadío clínico se evaluó la correlación entre los niveles de vitamina D y los resultados de las pruebas de laboratorio relacionadas con desordenes óseos y minerales, exposición solar y etnia. RESULTADOS: Se evaluaron 331 pacientes, con una edad media de 71 años, la mayoría mestizos (71%), 173 mujeres. La principal etiología de ERC fue nefropatía hipertensiva (33.2%). El 21.1% de los pacientes tenían niveles normales de vitamina D, fueron insuficientes en 70.1% y 8.8% en déficit. Se detectó correlación negativa, entre los niveles de vitamina 25(OH)D y los valores de creatinina, fósforo, producto calcio x fósforo, PTH, proteínas en orina de 24 horas e IMC. Correlación positiva para el calcio y la albumina. Se encontró significancia estadística positiva entre los niveles de vitamina 25(OH)D y la exposición solar para los estadios 3b y 4. CONCLUSIONES: En pacientes con ERC es comun detectar bajos niveles de 25(OH)D, los cuales pueden contribuir a la generación de hiperparatiroidismo secundario.
Assuntos
Insuficiência Renal Crônica/sangue , Vitamina D/sangue , Adulto , Idoso , Altitude , Calcitriol/sangue , Cálcio/metabolismo , Colômbia , Estudos Transversais , Ergocalciferóis/sangue , Feminino , Humanos , Hiperparatireoidismo/sangue , Hiperparatireoidismo/diagnóstico , Masculino , Hormônio Paratireóideo/sangue , Fósforo/sangue , Estudos Prospectivos , Luz Solar , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnósticoRESUMO
Abstract Objective: To establish the impact the chronic kidney disease stage has in the native vitamin D levels in patients not undergoing dialysis treatment. Methods: A study performed in Manizales, Colombia, a city located 2,200 meters above sea level, without important stational variations. Patients with 18 years of age or more, with chronic kidney disease stages 2 to 5 and not undergoing dialysis treatment were recruited for this study. Demographic and anthropometric variations were evaluated as well as solar exposure, CKD etiology and laboratory variables related to bone and mineral diseases. For each CKD clinical stage, correlations were evaluated for vitamin D levels, laboratory results for bone and mineral diseases, solar exposure and ethnicity. Results: Three hundred thirty-three patients were evaluated with a median age of 71 years, most of them mestizo (71%), 173 were women. The main CKD etiology was hypertensive nephropathy (32.2%). 21.1% of patients had normal vitamin D levels, 70.1% were within insufficient range and 8.8% were in deficit. A negative correlation was found between the levels of vitamin 25 (OH) D and the values for: creatinine, phosphorous, calcium x phosphorous product, PTH, 24 hours urine protein and BMI. A positive relationship was found for calcium and albumin. Positive significant statistical correlation was found for vitamin 25(OH) D levels and solar exposure for stages 3b and 4 of CKD. Conclusions: It is common to find low levels of vitamin 25(OH) D in patients with CKD; these can contribute to the appearance of secondary hyperparathyroidism.
Resumen Objetivo: Establecer el impacto del estadio clínico en los niveles de vitamina D nativa en pacientes con enfermedad renal crónica (ERC) sin diálisis. Métodos: Estudio realizado en Manizales, Colombia, una ciudad tropical ubicada a 2,200 metros de altura sobre el nivel del mar, sin variaciones estacionales importantes a lo largo del año. Se incluyeron pacientes mayores de 18 años, con enfermedad renal crónica estadio 2 a 5 sin tratamiento dialítico. En ellos se evaluaron variables demográficas, antropométricas, grado de exposición solar, etiología de la enfermedad, y variables de laboratorio relacionadas con desórdenes óseos y minerales. Para cada estadío clínico se evaluó la correlación entre los niveles de vitamina D y los resultados de las pruebas de laboratorio relacionadas con desordenes óseos y minerales, exposición solar y etnia. Resultados: Se evaluaron 331 pacientes, con una edad media de 71 años, la mayoría mestizos (71%), 173 mujeres. La principal etiología de ERC fue nefropatía hipertensiva (33.2%). El 21.1% de los pacientes tenían niveles normales de vitamina D, fueron insuficientes en 70.1% y 8.8% en déficit. Se detectó correlación negativa, entre los niveles de vitamina 25(OH)D y los valores de creatinina, fósforo, producto calcio x fósforo, PTH, proteínas en orina de 24 horas e IMC. Correlación positiva para el calcio y la albumina. Se encontró significancia estadística positiva entre los niveles de vitamina 25(OH)D y la exposición solar para los estadios 3b y 4. Conclusiones: En pacientes con ERC es comun detectar bajos niveles de 25(OH)D, los cuales pueden contribuir a la generación de hiperparatiroidismo secundario.
Assuntos
Insuficiência Renal Crônica , Vitamina D , Calcitriol , Cálcio , Hiperparatireoidismo/sangue , Hiperparatireoidismo/diagnóstico , Estudos Transversais SeriadosRESUMO
The authors conducted a review of the major aspects of progression of knowledge about the surgical treatment of hyperparathyroidism. Through literature review, we analyzed articles on the history of the evolution of anatomical, physiological, pathological and surgical knowledge of the parathyroid glands. Because of their unique anatomical features, the parathyroid glands were the last of the endocrine glands to be discovered, which greatly hindered proper treatment until the first decades of the twentieth century. Technological developments in the last 30 years greatly facilitated the location of the glands and hyperparathyroidism surgery. However, an experienced and dedicated surgeon is still essential to the excellence of treatment. RESUMO Os autores fizeram uma revisão dos principais aspectos históricos da progressão do conhecimento sobre o tratamento cirúrgico do hiperparatireoidismo. Por meio de revisão bibliográfica, foram analisados artigos selecionados sobre a história da evolução do conhecimento anatômico, fisiológico, patológico e cirúrgico das glândulas paratireoides. Devido às suas características anatômicas peculiares, as paratireoides foram as últimas das glândulas endócrinas a serem descobertas, o que dificultou sobremaneira seu tratamento adequado até as primeiras décadas do Século XX. A evolução tecnológica ocorrida nos últimos 30 anos facilitou sobremaneira a localização das glândulas e a cirurgia do hiperparatireoidismo. Contudo, um cirurgião experiente e dedicado ao tratamento dessa enfermidade ainda é fundamental para a excelência do tratamento.
Assuntos
Hiperparatireoidismo/cirurgia , Paratireoidectomia , Animais , Cálcio , História do Século XIX , História do Século XX , Humanos , Concentração de Íons de Hidrogênio , Hiperparatireoidismo/sangue , Glândulas Paratireoides/anatomia & histologia , Glândulas Paratireoides/fisiologia , Hormônio Paratireóideo/sangue , Paratireoidectomia/históriaRESUMO
ABSTRACT The authors conducted a review of the major aspects of progression of knowledge about the surgical treatment of hyperparathyroidism. Through literature review, we analyzed articles on the history of the evolution of anatomical, physiological, pathological and surgical knowledge of the parathyroid glands. Because of their unique anatomical features, the parathyroid glands were the last of the endocrine glands to be discovered, which greatly hindered proper treatment until the first decades of the twentieth century. Technological developments in the last 30 years greatly facilitated the location of the glands and hyperparathyroidism surgery. However, an experienced and dedicated surgeon is still essential to the excellence of treatment.
RESUMO Os autores fizeram uma revisão dos principais aspectos históricos da progressão do conhecimento sobre o tratamento cirúrgico do hiperparatireoidismo. Por meio de revisão bibliográfica, foram analisados artigos selecionados sobre a história da evolução do conhecimento anatômico, fisiológico, patológico e cirúrgico das glândulas paratireoides. Devido às suas características anatômicas peculiares, as paratireoides foram as últimas das glândulas endócrinas a serem descobertas, o que dificultou sobremaneira seu tratamento adequado até as primeiras décadas do Século XX. A evolução tecnológica ocorrida nos últimos 30 anos facilitou sobremaneira a localização das glândulas e a cirurgia do hiperparatireoidismo. Contudo, um cirurgião experiente e dedicado ao tratamento dessa enfermidade ainda é fundamental para a excelência do tratamento.