Ann Surg Treat Res.  2016 Sep;91(3):97-103. 10.4174/astr.2016.91.3.97.

Is focused parathyroidectomy appropriate for patients with primary hyperparathyroidism?

• Kim WW
• Rhee Y
• Ban EJ
• Lee CR
• Kang SW
• Jeong JJ
• Nam KH
• Chung WY
• Park CS

• KMID: 2350535
• DOI: http://doi.org/10.4174/astr.2016.91.3.97

Abstract

PURPOSE
The aim of this study was to determine whether focused or complete parathyroidectomy was more appropriate and to compare follow-up data in primary hyperparathyroidism (PHPT).
METHODS
We retrospectively analyzed 225 operations for PHPT at Yonsei University Health System between 2000 and 2012. After excluding 93 patients, the remaining 132 were divided into 2 groups: those who underwent focused parathyroidectomy (FP) and those who underwent conventional parathyroidectomy (CP). We compared clinicopathological features; preoperative calcium, parathyroid hormone (PTH), phosphorus, vitamin D, 24-hour urine calcium, and alkaline phosphatase levels; postoperative calcium and PTH levels; pathologic diagnosis; multiplicity; and results of a localization study between the 2 groups.
RESULTS
There was no significant difference in the rates of development of postoperative persistent hyperparathyroidism (1/122 FP patients and 1/10 CP patients) between the 2 groups due to a technical reason (FP 0.8% vs. CP 10.0%, P = 0.146). Multiglandular disease (MGD) was uncommon in all cases (6 of 132, 4.5%). All MGD cases were diagnosed using a preoperative localization study. Sestamibi scan and ultrasonography sensitivity were 94.2% and 90.2%, respectively.
CONCLUSION
We suggest that FP is appropriate in PHPT, except in cases of MGD if detected before the operation using preoperative imaging. Knowledge of hereditary PHPT and improved preoperative localization studies, such as high-resolution ultrasonography, contributed to the decision to perform FP rather than CP in all cases of unilateral results of the localizing study.

Keyword

Primary hyperparathyroidism; Parathyroidectomy; Ultrasonography; Technetium Tc 99m Sestamibi

MeSH Terms

Alkaline Phosphatase
Calcium
Diagnosis
Follow-Up Studies
Humans
Hyperparathyroidism
Hyperparathyroidism, Primary*
Parathyroid Hormone
Parathyroidectomy*
Phosphorus
Retrospective Studies
Technetium Tc 99m Sestamibi
Ultrasonography
Vitamin D
Alkaline Phosphatase
Calcium
Parathyroid Hormone
Phosphorus
Technetium Tc 99m Sestamibi
Vitamin D

Figure

• 

  Fig. 1 Characteristics of the cases excluded. PHPT, primary hyperparathyroidism; CRF, chronic renal failure; MEN, multiple endocrine neoplasia; HPT, hyperparathyroidism; MIBI, sestamibi; USG, ultrasonography.

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