The utility of routine transcervical thymectomy for multiple endocrine neoplasia 1-related hyperparathyroidism

Background. Operation for multiple endocrine neoplasia (MEN) 1-related hyperparathyroidism (HPT) includes a neck exploration with resection of 3.5 or 4 parathyroid glands and transcervical thymectomy (TCT). We reviewed our experience with initial operation for primary HPT to determine the outcome and utility of routine TCT. Methods. All patients with MEN1 who underwent initial neck exploration from 1993 to 2007 under an institutional review board-approved protocol were reviewed. Results. We identified 66 patients with initial operation for HPT in MEN1. In 34 patients, 4 glands were found; in 32 patients, <4 glands were found. In 2 of the 34 (6%) and 17 of the 32 (53%), intrathymic parathyroid tissue was found on permanent pathology. No thymic carcinoid tissue was found in any specimen. Conclusion. These data highlight the importance of performing TCT when <4 entopic parathyroid glands are found at first operation. (Surgery 2008; 144:878-84.)