Defining failure after parathyroidectomy for primary hyperparathyroidism: case series

To identify the cause of operative failure in patients who have undergone parathyroid surgery for primary hyperparathyroidism.

Retrospective case review.

Patients who had undergone a primary procedure for primary hyperparathyroidism between July 2003 and December 2007. Cases with incomplete post-operative serum calcium data were excluded.

Operative failure was defined as failure to achieve normalisation of serum adjusted calcium levels post-operatively.

A total of 220 primary procedures were conducted over 4.5 years. Data were not available for 16 patients. Thirteen procedures (6.4 per cent) were considered failures, and these cases were individually reviewed and classified according to the reason for failure.

Establishing the cause of failure following surgery for primary hyperparathyroidism can be a complex task. In some instances, diagnostic uncertainty remains despite detailed biochemical and radiological assessment. This paper outlines our approach to maximising the cure rate at primary surgery.