Treatment of Primary Hyperparathyroidism with Suspected Parathyroid Carcinoma

Parathyroid carcinoma is an uncommon cause of primary hyperparathyroidism, accounting for approximately 0.5% of all cases. When malignant parathyroid disease is suspected — either before the operation or during it — the clinical approach differs from standard PHPT management, and input from a specialist centre is essential.

Clinical scenario: Preoperative or intra-operative suspicion of parathyroid carcinoma. Given its rarity, consultation from an experienced endocrine surgery unit should be obtained whenever this diagnosis is under consideration.

Surgical approach — key principle

Surgery is the only curative modality in this setting. The operative strategy centres on en-bloc resection; the full details of which structures may be involved and the complete surgical algorithm are available in the structured protocol below. Importantly, needle biopsy is not performed in this scenario.

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References

DOI: 10.1111/cen.14650

Parathyroid carcinoma is uncommon (approximately 0.5% of all PHPT cases).
Where there is preoperative or intra-operative suspicion of parathyroid carcinoma, consultation from an experienced endocrine surgery unit should be obtained.
Surgery is the only curative treatment modality and en-bloc resection of the disease with invaded structures is key.
Principles involve en-bloc resection of disease in continuity with involved tissues.
This may require en-bloc resection of adjacent thyroid tissue (lobectomy) and may also require partial resection of strap muscles, trachea, oesophagus and recurrent nerve.
Needle biopsy should not be performed.

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