Results of surgery in primary hyperparathyroidism

In a prospective study 92 consecutive patients with biochemically proved primary hyperparathyroidism underwent initial neck exploration at Oulu University Hospital. The incidence of multiglandular disease was 34%. 23 patients (25%) underwent a simultaneous thyroidectomy. The cure rate after initial exploration was 91.3%, ectopic parathyroid glands and multiglandular disease being the most common causes of failure. Simultaneous thyroidectomy increased somewhat but not significantly the complication risk. There was a slight tendency for serum calcium concentrations to increase during the mean follow-up of 2.3 +/- 1.5 years. Four patients with persistent hypercalcaemia underwent a successful reoperation during that time. Thus the overall cure rate was 95.6%, but 5.4% of the patients required permanent medication for hypocalcaemia. We conclude that the most common causes for failed initial exploration were ectopic parathyroid glands and multiglandular disease. The incidence of multiglandular disease was unusually high in this series. Because simultaneous thyroidectomy increased somewhat the complication risk of initial neck exploration, the indications for this additional procedure should be carefully considered. The results of parathyroid surgery were good and dependent on how many patients underwent reoperation during the follow-up. A consequence of tendency for serum calcium concentrations to increase during the follow-up could be that a definite cure cannot always be attained in cases of primary hyperparathyroidism.