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March 1994

Primary Hyperparathyroidism: Low Surgical Morbidity Supports Liberal Attitude to Operation

Author Affiliations

From the Department of Surgery, Karolinska Hospital, Stockholm, Sweden.

Arch Surg. 1994;129(3):237-240. doi:10.1001/archsurg.1994.01420270011002

Objective:  To evaluate the results of a modern surgical approach in patients with primary hyperparathyroidism.

Design:  Retrospective analysis.

Setting:  University hospital, tertiary care center.

Patients:  One hundred patients consecutively operated on for suspected primary hyperparathyroidism. Patients were available for follow-up 1 month (n=100) and 1 year (n=96) after surgery.

Intervention:  Cervical exploration. Surgical strategy was to remove enlarged parathyroid glands only and perform a biopsy on no more than one normal gland.

Main Outcome Measures:  Surgical morbidity and normocalcemia.

Results:  No operative mortality or wound infection occurred in any patient. Postoperative vocal cord paralysis was recorded in two patients; both recovered fully. Two patients underwent a second operation. (One patient experienced subcutaneous bleeding and the second patient, previously operated on for toxic goiter, experienced persistent hypercalcemia and was operated on 5 days after the initial operation. A second abnormal gland was then found on the contralateral side, not initially surgically explored.) At follow-up, 97 patients were normocalcemic; three patients had hypoparathyroidism: two of these patients, with multiglandular disease, were normocalcemic and received a low dose of vitamin D (1α[OH]D3), and one patient, who had had a single adenoma removed, was slightly hypocalcemic, however, asymptomatic.

Conclusions:  More than 90% of patients with primary hyperparathyroidism can be operated on without complications occurring. This supports a liberal attitude to operation.(Arch Surg. 1994;129:237-240)

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