Is focused parathyroidectomy appropriate for patients with primary hyperparathyroidism?

Won Woong Kim, Yumie Rhee, Eun Jeong Ban, Cho Rok Lee, Sang Wook Kang, Jong Ju Jeong, Kee Hyun Nam, Woong Youn Chung, Cheong Soo Park

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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 highresolution ultrasonography, contributed to the decision to perform FP rather than CP in all cases of unilateral results of the localizing study.

Original languageEnglish
Pages (from-to)97-103
Number of pages7
JournalAnnals of Surgical Treatment and Research
Volume91
Issue number3
DOIs
Publication statusPublished - 2016 Sep

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All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Kim, W. W., Rhee, Y., Ban, E. J., Lee, C. R., Kang, S. W., Jeong, J. J., Nam, K. H., Chung, W. Y., & Park, C. S. (2016). Is focused parathyroidectomy appropriate for patients with primary hyperparathyroidism? Annals of Surgical Treatment and Research, 91(3), 97-103. https://doi.org/10.4174/astr.2016.91.3.97