Persistence of primary hyperparathyroidism: a single-center experience

Area of Science:

• Endocrinology
• Surgical Oncology
• Medical Imaging

Background:

• Parathyroidectomy is the definitive treatment for primary hyperparathyroidism (PHPT).
• Accurate localization of abnormal parathyroid glands is crucial for successful surgery.
• Focused parathyroidectomy carries a risk of persistent PHPT due to undiagnosed multiglandular disease (MGD).

Purpose of the Study:

• To evaluate the effectiveness of preoperative imaging in detecting multiglandular disease (MGD).
• To assess the risk factors for persistent PHPT and MGD.
• To compare the outcomes of focused parathyroidectomy versus bilateral neck exploration.

Main Methods:

• Retrospective analysis of 810 patients undergoing initial PHPT surgery (2017-2018).
• Evaluation of preoperative imaging (ultrasound, MIBI, 4D CT) results.
• Multivariate logistic regression to identify predictors of persistent PHPT and MGD.

Main Results:

• MGD was a primary cause of persistent PHPT.
• A history of thyroid surgery was a significant risk factor for persistent PHPT.
• Preoperative imaging showed low to moderate sensitivity for MGD detection; no modality reliably ruled out MGD.
• Focused parathyroidectomy and bilateral neck exploration showed similar persistence rates.

Conclusions:

• No combination of preoperative imaging could reliably exclude MGD or select patients for focused parathyroidectomy.
• Additional preoperative imaging did not improve overall surgical outcomes.
• Bilateral neck exploration may offer a slight advantage for patients with concordant preoperative imaging results.