Surgical management of hyperparathyroidism

Twenty-one patients with hyperpara-thyroidism were studied to determine the outcome of surgical treatment by a variety of surgeons using a variety of techniques. Primary surgical treatment was excision of an adenoma in 11 patients with primary hyperparathyroidism. One patient (7%) had a true recurrence. One patient (7%) had persistent disease. Subtotal parathyroidectomies were carried out in three patients with primary diffuse hyperplasia and in five patients with chronic renal disease. Total parathyroidectomy and autotransplantation were performed in two more recent patients with chronic renal disease. Permanent hypoparathyroidism was not seen postoperatively in patients with primary hyperparathyroidism. Identification of all four glands at the operating table is essential. The low recurrence rate following selective excision of diseases parathyroid glands in this series suggests that the approach can be undertaken safely in most instances.