Parathyroidectomy: Extent of resection and late results

Abstract

Opinion is divided as to the necessary extent of parathyroid resection in primary hyperparathyroidism. Some surgeons urge that subtotal parathyroidectomy be performed routinely, while others reserve subtotal resections for patients with parathyroid hyperplasia. In a review of 102 patients treated by parathyroidectomy for primary hyperparathyroidism and subsequently followed up for an average of 6 years, there were 73 patients with parathyroid adenoma, 26 with hyperplasia and 3 with carcinoma. The adenoma was not found at the first operation in only 3 cases; in the other 70 after removal of the adenoma no further hypercalcaemia was observed during the follow-up period. Persistent or recurrent hypercalcaemia was a problem in 9 out of the 26 patients with primary hyperplasia who had inadequate resection at the first operation, and also in the 3 patients with carcinoma. Experience shows that peroperative biopsy with frozen section of all the parathyroids is useful in confirming their identity and can be a guide to the type of disease present and the appropriate extent of resection.

Invited commentary

“…: personal communication). These data have been confirmed by Cooke et al [3] and by van Heerden et al [4] who reported single adenomas in 89% of 207 patients treated at the Mayo Clinic between 1967 and 1970. Further, these authors [4] quoted the study by Parnell, Scholz, and Beahrs which showed in a 1-8 year follow-up a diagnostic error rate of less than a 1% as revealed by recurrence of the hypercalcemia (presumably due to parathyroid hyperplasia).…”

Single and multigland disease in primary hyperparathyroidism: Clinical follow‐up, histopathology, and flow cytometric DNA analysis

“…Bilateral and unilateral surgical approaches have been advocated. Some surgeons Use the histological appearance of parathyroid tissue at frozen section to determine the extent of parathyroidectomy [1][2][3]. When a hyperplastic parathyroid gland is reported by the Pathologist, 3 or 31/2 parathyroids are removed.…”

Primary hyperparathyroidism in a district general hospital

“…The majority of large series of patients with primary hyperparathyroidism have been reported from major teaching centres 1 , 2 , 3 , 4 , 5 . In Great Britain, studies have also been reported from major cities 6 , 7 or metropolitan areas 8 , following mass biochemical screening programmes or the collection of data from major hospitals within an area, but few studies have been reported from peripheral units 9 or clinics.…”