Exploring surgical failures in primary hyperparathyroidism.

INTRODUCTION

Parathyroidectomy is considered the most cost-effective treatment for primary hyperparathyroidism (PHPT), with a relatively low incidence of complications. Nonetheless, 5-10% of patients do not achieve cure after initial parathyroidectomy. We hereby report our experience to determine the causes of our uncured patients and explore factors that could be associated with failure.

METHODS

We conducted a retrospective case series study and reviewed all the patients who underwent surgery for PHPT from 2004 to 2020. Cure was defined as re-establishment of normal calcium homeostasis lasting a minimum of 6 months. Persistent PHPT (perPHPT) was defined as ongoing hypercalcemia at any time within the 6 months after surgery.

RESULTS

The overall failure-to-cure rate was 6%. Of the 165 patients, 155 underwent successful surgical treatment of PHPT at the initial operation and perPHPT occurred in 10 patients. Baseline factors including age, sex, preoperative laboratory values, imaging, and surgical approach did not differ significantly between cured and non-cured groups. The sensitivity of intraoperative PTH measurement (iOPTH) as an indicator of operative success was 88,5%. Of the 10 patients with perPHPT, multi-gland disease (MGD) was present in 7 and ectopic adenoma in one. The lack of iOPTH use contributed to failure in 2 cases.

CONCLUSION

Our study underscores the critical role of MGD as a significant cause of perPHPT. Other etiologies may include ectopic glands or technical problems during surgery. The use of iOPTH is crucial in reducing the incidence of perPHPT and should be a routine practice.