Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Thymectomy is commonly performed during parathyroidectomy (PTX) for primary hyperparathyroidism (pHPT) in multiple endocrine neoplasia (MEN). Recently, many individual institutional reports question the impact of thymectomy on post-operative outcomes and concluded unnecessary need for routine thymectomy. We aimed to evaluate the impact of concomitant thymectomy with PTX on cure rate, reoperation rate, and post-operative hypoparathyroidism (hypoPT) rate in patients with MEN1.
Methods: This retrospective study used the TriNetX research platform, Global collaborative network representing over 130 million patients globally. We identified 434 patients with MEN type 1 who underwent PTX. The outcomes assessed were reoperation, cure rate, persistent and recurrent disease, and transient and permanent hypoparathyroidism (hypoPT). Outcomes were compared between 129 thymectomy cases and 305 controls without thymectomy.
Results: The thymectomy group were younger (mean age 44 ± 18) compared to 52 ± 17 without thymectomy and had more male patients (44%) compared to (34%) in the control group. Adding thymectomy to PTX was associated with significantly higher cure rates 97.7% (126) compared to 88.6% (269), p=0.0008 with 10% increase in cure rate (RR: 1.1; 95%CI: 1.04 – 1.16). In addition, 74% reduction in persistent disease risk (RR=0.26, 95%CI:0.10-0.72) compared to PTX alone. While transient hypoparathyroidism rates rose with thymectomy (38% vs 24.3%, p=0.011), no difference existed in permanent complications (3.1% with thymectomy vs 1.6% for controls, p=0.09).
Conclusion: Combining thymectomy with PTX was associated with higher cure rates, less persistent disease, and no increase in permanent hypoparathyroidism, despite more transient hypoPT. Given the benefits on cure rate and persistent disease, thymectomy