Persistent disease after surgery for primary hyperparathyroidism: the long-term outcome

Abstract

Objective: Nineteen patients with persistent primary hyperparathyroidism were investigated to evaluate their clinical and laboratory status a long time after treatment was ended. The risk of persistent disease and need for extensive surgery for cure, i.e. more than two neck operations, or mediastinal exploration, was also evaluated. Design: The medical records of 896 consecutive patients operated on for primary hyperparathyroidism were scrutinised at follow-up, a mean of 10.3 years after surgery. Data on state of health, medication, bone fractures and other diagnoses were collected by use of a questionnaire. There were 600 patients still alive, among whom 13 had persistent disease and they were compared with 509 patients who were cured and without any suspicion of recurrent disease, according to laboratory examination. Results: Serum calcium and creatinine values had with few exceptions remained stable over the years. In five patients, serum calcium levels were within the normal range at follow-up. Still, all 19 patients were considered hyperparathyroid. They had substantial cardiovascular morbidity, and their state of health was not as good as that of the patients who were surgically cured. After one operation, 5.5% (95% confidence interval (CI) 4.0-7.2%) had persistent disease, and 2.1% after reoperation. Extensive surgery for cure was performed in 2% of the patients (95% CI 1.1 -3.2%). Conclusions: We found that the state of health was significantly better for patients with cured primary hyperparathyroidism than for patients with persistent disease, but serious deterioration of laboratory values was uncommon. The result of the present study supports surgical treatment.

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

“…The biochemical diagnosis of persistent and recurrent primary hyperparathyroidism is the same as for the initial diagnosis of primary HPT, specifically, hypercalcemia in the presence of a high or inappropriately unsuppressed parathyroid hormone (PTH) level …”

“…In those patients who underwent parathyroid surgery, but did not meet any specific guidelines, the decision to consider another parathyroid operation is not straightforward. Asymptomatic patients with primary hyperparathyroidism have been followed for up to a decade without overt evidence of clinically significant disease progression …”

“…Vitamin D sufficiency is important because vitamin D deficiency in primary hyperparathyroidism is associated with greater manifestations of biochemical abnormalities and target organ compromise . Because vitamin D deficiency is associated with more severe manifestations of hyperparathyroidism, it seems prudent to aim for levels >30 ng/mL . In patients who are vitamin D deficient, cautious replacement with judicious amounts of cholecalciferol (vitamin D3) starting with 1000 IU/day is wise.…”

“…Reoperative parathyroid surgery can be associated with significant risks. It may be required in as many as 10% of operated patients with primary hyperparathyroidism . Reoperative parathyroid surgery is a complex exercise that requires specialized skills and understanding to successfully optimize patient care.…”

Hyperparatirosis and Cardiovascular System Pathology

“…[75]. Stefenelli [32] сообщает о том, что у пациентов с сохраняющим-ся повышенным уровнем ПГ после операции не наблюдается регресса ГЛЖ, который отмечен у других пациентов.…”