Results and complications of the surgical treatment of primary hyperparathyroidism

Between the late 1960's and 1980, the operation for primary hyperparathyroidism at The University of Chicago changed from subtotal parathyroidectomy for all patients to removal of an adenoma with performance of biopsies of all other normal glands. After 1980, our technique was again modified to bilateral neck exploration, resection of the adenoma when it was present, and performance of fewer biopsies of normal glands (usually one and sometimes two). Between 1980 and 1990, 308 parathyroidectomies were performed; 288 patients underwent first operations. Two hundred forty-five (85.1%) of these patients had an adenoma and forty-three (14.9%) had hyperplasia (multiglandular disease); none had a carcinoma. Resolution of hypercalcemia with the first operation was achieved in 281 patients (97.5%); seven patients experienced failed explorations. The early cure was the same whether or not preoperative localization studies were performed. Biopsy of fewer normal parathyroid glands when an adenoma was present resulted in a decreased incidence of transient postoperative hypocalcemia. Nineteen patients underwent 20 reoperative parathyroidectomies during this period. Preoperative localization studies; done in 16 (80%) of 20 cases, were very helpful. Ninety percent of patients with abnormal parathyroid glands in their neck or mediastinum were cured with their initial reoperation.