Surgical outcome of primary hyperparathyroidism and factors correlated with preoperative serum iPTH concentration

We aimed to evaluate whether early surgical intervention remains the optimal treatment strategy for primary hyperparathyroidism (PHPT), in light of recent advances in conservative management, by assessing surgical outcomes and examining the clinicopathological factors associated with preoperative intact parathyroid hormone (iPTH) levels.

We retrospectively analyzed 80 patients (19 men and 61 women; mean age, 56.8 years) who underwent parathyroidectomy for PHPT between 2014 and 2023. Clinical subtypes were classified as renal, biochemical, or skeletal. Collected data included preoperative and postoperative serum calcium and iPTH levels, imaging findings from ultrasonography and 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy, pathological diagnoses, and immunohistochemical expression of Cyclin D1 and Ki-67.

Renal-type PHPT was the most common subtype (52.5%), followed by biochemical (26.3%) and skeletal (21.2%) types. Parathyroid adenomas accounted for the majority of pathological diagnoses (79.6%). The concordance rate for gland localization using combined ultrasonography and MIBI scintigraphy was 72.1%. Surgery led to significant reductions in serum calcium (from 11.1 to 9.1 mg/dL) and iPTH levels (from 201.8 to 37.5 pg/mL). Tumor size was positively correlated with preoperative iPTH levels, whereas Cyclin D1 and Ki-67 expression were not.

Parathyroidectomy yields favorable biochemical outcomes in patients with PHPT and remains the most effective strategy for preventing disease progression. Tumor size was the only factor associated with elevated preoperative iPTH levels. Persistent postoperative iPTH elevation in some patients underscores the importance of early diagnosis and timely surgical intervention, particularly before irreversible systemic complications arise.