The role of routine biopsy of all parathyroid glands in primary hyperparathyroidism

Since 1974, a concerted effort has been made to identify and biopsy all parathyroid glands in patients presenting with primary hyperparathyroidism. From 1974 until July 1982, 247 patients had initial cervical exploration for primary hyperparathyroidism. The percentage of patients in whom four or more glands were identified rose from 53 per cent in 1974 to as high as 88 per cent, with a mean of 80 per cent during the 8.5-year period. Ectopic location, prior thyroid surgery, and detrimental effects of prolonging surgery in some patients are reasons precluding localization of all glands in every patient. The percentage of biopsies positive for parathyroid tissue rose from 78 per cent in 1974 to 94 per cent in 1982. Routine biopsy of all glands provided the following results of classification in the 247 cases: adenoma, 56 per cent; diffuse hyperplasia, 18 per cent; nodular hyperplasia, 24 per cent; carcinoma, 0.8 per cent; and in three cases, four normal glands were identified. The one major complication was a case of temporary bilateral recurrent laryngeal nerve palsy. Mean follow-up period is 3 years. There was no case of permanent hypocalcemia and no operative deaths. Persistence and recurrence rates are 4.9 per cent and 0.4 per cent, respectively. Four of the patients with persistence and the one patient with recurrence have required reexploration. All but one of these was considered cured by reoperation. Eight of the 12 patients with initial persistent hypercalcemia postoperatively have been managed conservatively. These results suggest routine attempts to identify and biopsy all glands can be performed with minimal risk and complications and without permanent hypocalcemia.(ABSTRACT TRUNCATED AT 250 WORDS)