Perspectiva quirúrgica del cuello en neoplasia endocrina múltiple tipo 1 (NEM1)

Aim: To present our experience using intraoperative PTH monitoring in primary hyperparathyroidism surgery in patients with multiple endocrine neoplasia type I. Materials and Methods: Five patients with multiple endocrine neoplasia type I confirmed by genetic testing. They were evaluated by a multidisciplinary team. All cases underwent bilateral neck exploration and subtotal parathyroidectomy with intraoperative PTH monitoring. Clinical presentation, intraoperative findings and follow up are described. Results: All cases underwent bilateral neck exploration with PTH measurements at induction of anesthesia (basal) and then at 15 and 30 minutes from gland excision. In three cases the surgical plan was changed according to the results of PTH monitoring. All patients had normal recovery and were discharged in good conditions. Follow up to 34 months is presented. Discussion: No international guidelines on intraoperative PTH monitoring among patients with primary hyperthyroidism due to multiple endocrine neoplasia type I were found. Using intraoperative PTH monitoring could help tailoring each patient’s treatment to individual needs for ultimately achieving prolonged eucalcemia.