Success of cervical exploration for patients with asymptomatic primary hyperparathyroidism

This study examined the success and safety of cervical exploration in patients with asymptomatic primary hyperparathyroidism compared with those with symptomatic disease.

Records of patients undergoing cervical exploration for primary hyperparathyroidism from June 1990 to October 1996 were reviewed. Patients were divided into three groups: (1) asymptomatic, (2) symptomatic, and (3) afflicted (those with associated complications). Information collected consisted of preoperative and postoperative symptoms, serum calcium and parathyroid hormone levels (PTH), and descriptions of pathologic and operative findings.

Sixty-one patients were identified. Nineteen (31%) had no symptoms, 21 (34%) had subjective symptoms, and 21 had associated conditions, as described. Average preoperative and postoperative calcium levels were 11.5 mg% and 8.5 mg%, respectively. Average PTH levels also fell from 142 pg/mL to 49 pg/mL after surgery. Preoperative and postoperative calcium and PTH levels for the three groups showed no significant differences. The success of surgery in identifying pathology ranged from 90.5% to 95%, and again showed no difference among the three groups. Long-term morbidity (>6 months) in all groups was 0%.

Cervical exploration and parathyroidectomy for asymptomatic primary hyperparathryoidism is safe and has similar success rates in identifying pathology and correcting biochemical abnormalities compared with patients with symptomatic disease.