Effectiveness of surgical treatment of primary hyperparathyroidism with urolithiasis: correction of symptoms, laboratory parameters and stone-forming risk

Abstract

Background. Parathyroidectomy is the only effective method to improve the clinical and laboratory manifestations of the primary hyperparathyroidism (PHPT) and reduce the risk of urinary calculi formation. However, there are controversies about the existence of renal form of PHPT and about the effectiveness of surgery with regard to the risk of stone formation.
 Aims. To evaluate the effectiveness of PHPT surgical treatment in relation to clinical, laboratory parameters, as well as the risk of stone formation.
 Materials and methods. In a prospective single-arm observation one-center nonrandomized study we included patients with PHPT in whom parathyroidectomy was performed in 2012–2015. We analyzed clinical and laboratory parameters before and after surgery in a period from 1 to 3 years.
 Results. The study included 105 patients, of whom 35 (33.3%) had urolithiasis. Blood calcium after the surgery decreased from 2.72 mmol/l [2,56; 2,97] to 2,3 mmol/l [2,2; 2,35], p < 0.001. Blood calcium concentration decreased to normal values in all patients. Parathyroid hormone level decreased from 206 pg/ml [123; 347] to 72,8 pg/ml [30; 113], p < 0.001. Clinical symptoms questionnaire estmation decreased from 4 points [3; 6] to 2 points [1; 4], p < 0.001. In patients with urolithiasis clinical symptoms before treatment were more pronounced – 5 points [3; 7] vs. 4 points [3; 5] (p = 0.015) and decreased more significantly – by 3 points [2; 4] vs 2 points [1; 3]. The daily calcium urine excretion decreased from 11.4 mmol/day [8.9; 13.9] to 5.4 mmol/day [4.1; 6.8], p < 0.001. In 2 cases (5.7%; CI, 0.7–19.2%) we observed the progression of urolithiasis after surgery. The age of patients correlated with daily calcium urine excretion after surgery (r = 0.69; p = 0.028).
 Conclusions. Parathyroidectomy normalizes blood calcium and parathyroid hormone, improves clinical symptoms and reduces the risk of stone formation.

Distant Results of Stage-by-Stage Parathyroidectomy

“…Наличие и расположение увеличенной ОЩЖ было доказано с помощью последовательно выполненных УЗИ и тонкоигольной аспирационной пункционной биопсии с определением уровня ПТГ в аспирационном материале (ТАПБ/ПТГ). Средняя длина увеличенных ОЩЖ составила 12,51±0,42 мм, ширина -7,16±0,32 мм, толщина -5,26,22 мм; средний объем -0,48±0,09 см 3 На рисунке 3 представлена локализация выявленных измененных ОЩЖ. Нижняя левая ОЩЖ была визуализирована в 9 случаях (40,9%), нижняя правая -в 7 (31,82%), верхняя левая -в 3 (13,64%), верхняя правая -в 3 (13,64%).…”

“…У второго пациента до выполнения ЧЛА, единственная ОЩЖ была обнаружена по задней поверхности среднего сегмента левой доли щитовидной железы размером 11,6×7,1×4,2 мм, объемом 0,17 см 3 . После выполнения 1 сеанса ЧЛА, уровень ПТГ и Са++ нормализовались и сохранялись на уровне нормы в течение 6 месяцев.…”