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April 1989

Primary Hyperparathyroidism: A Review of the Long-term Surgical and Nonsurgical Morbidities as a Basis for a Rational Approach to Treatment

Author Affiliations

From the Departments of Medicine (Dr Lafferty) and Surgery (Dr Hubay), University Hospitals of Cleveland and Case Western Reserve School of Medicine, Cleveland.

Arch Intern Med. 1989;149(4):789-796. doi:10.1001/archinte.1989.00390040031006

• We studied long-term morbidity after parathyroid surgery for primary hyperparathyroidism in 100 patients and compared it with the long-term morbidity of medical follow-up from the literature. The surgical treatment of primary hyperparathyroidism was associated with negative results of neck explorations, persistent hypercalcemia, recurrent hypercalcemia, permanent hypoparathyroidism, or recurrent laryngeal nerve damage in 13 (19%) of 68 patients followed up for five years postoperatively. A review of medical follow-up as reported in the literature showed progression of disease in 8% to 22% of patients followed up for five to ten years. There was no convincing evidence that mild primary hyperparathyroidism resulted in progressive osteoporosis or renal failure. Furthermore, no significant improvement in hypertension, peptic ulcer disease, or renal function followed successful parathyroid surgery. Unless future studies demonstrate progressive osteoporosis or renal damage in untreated, mild primary hyperparathyroidism, medical follow-up is a reasonable alternative to surgery in the compliant patient over 50 years of age.

(Arch Intern Med 1989;149:789-796)