Primary hyperparathyroidism. Low surgical morbidity supports liberal attitude to operation
M. Kjellman, K. Sandelin and L. O. Farnebo
Department 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.
