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Primary hyperparathyroidism. Low surgical morbidity supports liberal attitude to operation
M Kjellman1, K Sandelin, L O Farnebo
1Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
Objective:
To evaluate the results of a modern surgical approach in patients with primary hyperparathyroidism.
Design:
Retrospective analysis.
Setting:
University hospital, tertiary care center.
Patients:
One hundred patients consecutively operated on for suspected primary hyperparathyroidism. Patients were available for follow-up 1 month (n = 100) and 1 year (n = 96) after surgery.
Intervention:
Cervical exploration. Surgical strategy was to remove enlarged parathyroid glands only and perform a biopsy on no more than one normal gland.
Main Outcome Measures:
Surgical morbidity and normocalcemia.
Results:
No operative mortality or wound infection occurred in any patient. Postoperative vocal cord paralysis was recorded in two patients; both recovered fully. Two patients underwent a second operation. (One patient experienced subcutaneous bleeding and the second patient, previously operated on for toxic goiter, experienced persistent hypercalcemia and was operated on 5 days after the initial operation. A second abnormal gland was then found on the contralateral side, not initially surgically explored.) At follow-up, 97 patients were normocalcemic; three patients had hypoparathyroidism: two of these patients, with multiglandular disease, were normocalcemic and received a low dose of vitamin D (1 alpha [OH]D3), and one patient, who had had a single adenoma removed, was slightly hypocalcemic, however, asymptomatic.
Conclusions:
More than 90% of patients with primary hyperparathyroidism can be operated on without complications occurring. This supports a liberal attitude to operation.