Surgical aspects of primary hyperparathyroidism.

A series of 217 operations performed for primary hyperparathyroidism between 1965 and 1978, was studied to evaluate the peroperative findings and to assess the results of surgical treatment. There was a greater incidence in women than in men, a ratio of 2.5:1. Although occurring at any age, the incidence was higher for women over the age of 45. During all 217 neck explorations it was attempted to identify all parathyroid glands. In 89% of cases three or more glands were found. Of the 746 glands, 74% were situated normally and 12% were found inside the thymus. Histological examination confirmed hyperplasia in 50% of the patients, but one enlarged gland was found in each of 155 patients (70%). This shows a discrepancy based on microscopic findings by the pathologist and macroscopic findings by the surgeon concerned. Until today it has been our policy to remove the enlarged gland and to biopsy at least one other normally sized gland. Only when three or more glands are involved, a subtotal parathyroidectomy is recommended. The success rate of our primary operation is 96%. Complications due to severe hypocalcaemia or permanent vocal cord palsy have not been observed.