Duke endocrine surgeons who perform high-risk parathyroidectomies are now offering patients the option of preserving some portion of the resected parathyroid tissue as a back-up plan for treating the unlikely but devastating possibility of having no working parathyroid tissue left behind.
Although cryopreservation of parathyroid tissue has been done for years, it is offered only by certain medical centers using advanced cryobanks to help surgeons guard against the rare condition of acquired hypoparathyroidism. The cryopreserved tissue can be autotransplanted, typically in the forearm if the hypoparathyroidism does not resolve. Duke’s Robertson Clinical and Translational Cell Therapy Program serves as the repository for preserved tissue.
The risk of permanent hypocalcemia following a remedial neck operation can be as high as 30% because of the challenges of determining the viability of the remaining parathyroid glands. Cryopreservation is typically recommended in re-operative cases for primary hyperparathyroidism and in patients with 4-gland hyperplasia who are at risk for having too little functional parathyroid tissue left behind.
“For patients facing a redo surgery, cryopreservation is a great strategy, a back-up plan that is reassuring to the patient,” says Julie A. Sosa, MD, a surgeon and leader of the Endocrine Neoplasia Diseases Group in the Duke Cancer Institute.
Sosa, who helped launch the cryopreservation initiative 4 years ago, says her practice includes 25% to 30% remedial parathyroid surgeries. The most common presentation is primary hyperparathyroidism. Tissue preservation is also offered to patients with multiple endocrine neoplasia type 1 (MEN1).
“Patients with MEN1-associated hyperparathyroidism present very young--in their 20s, 30s or 40s--so they are going to live another 3 to 4 decades,” Sosa says. “There’s a good chance the disease will slowly recur over time, so tissue preservation offers a safety net that makes sense for most patients.”
The overall number of cryopreservation cases remains relatively low, as special handling and storing is necessary, Sosa says, but the practice is becoming more common. She has preserved tissue from 10 surgeries during the past 4 years, and she has autotransplanted 2 of the preserved samples. Other Duke endocrine surgeons who offer tissue preservation include Sanziana A. Roman, MD, Randall P. Scheri, MD, and Michael T. Stang, MD.
“Given our high remedial procedure load and the volume of patients we work with, cryopreservation is a perfect option for patients facing difficult surgeries. It provides a well-planned safety net,” Sosa says.