Parathyroidectomy effective for primary hyperparathyroidism regardless of localization technique

Parathyroidectomy yields excellent surgical outcomes in patients with primary hyperparathyroidism (PHPT), whether or not intraoperative localization technique (IOLT) or intraoperative parathyroid hormone (IOPTH) monitoring have been used, reports a recent study.

Researchers retrospectively reviewed 78 PHPT patients (mean age 54.8 years, 73.1 percent women) who had undergone parathyroidectomy, of whom 53.8 percent (n=42) and 76.9 percent (n=60) had IOLT and IOPTH monitoring, respectively.

In all 78 participants, parathyroidectomy resulted in the identification and excision of pathological parathyroid glands, which corresponded to a 100-percent success rate. Final pathology analysis found adenoma in all 78 patients, with a mean tumour diameter of 1.9 cm. The mean operating time was 78.8 minutes.

Of the 60 patients with IOPTH monitoring, the 10-minute IOPTH decreased by >50 percent from baseline, dropping to within the normal range in 70.0 percent (n=42) of patients, but remained above the normal in 25.0 percent (n=15) of patients.

Parathyroid hormone levels normalized on postoperative days 0 and 1 in majority of the patients, though >10 percent needed 9 days before such normalization occurred. All patients achieved surgical cure after a mean follow-up of 29.8 months. One patient developed recurrence 48 months after the initial surgery and underwent a second parathyroidectomy.

“Surgical outcomes of parathyroidectomy for PHPT were excellent, regardless of IOLT and IOPTH monitoring. However, these techniques can maximize the performance of parathyroid surgery by reducing operating time and rescuing challenging cases,” the researchers said.