title: [Surgery of primary hyperparathyroidism in 1988. Strategies during primary operations, in case of failure and in case of cancer].
abstract: In primary hyperparathyroidism, an operation is indicated when the calcemia exceeds 115 mg/l and phosphoremia is low in several successive instances, regardless of the symptoms, even if PTH levels and cervical ultrasonography are normal. In case of calcemia under 110 mg/l, the diagnosis must be confirmed by titration of the nephrogenic cyclic AMP and symptomatic patients must be operated upon as well as asymptomatic patients with a life expectancy exceeding 10 years. In case of acute hypercalcemia, the procedure must be performed as a semi-emergency without waiting for a definite diagnosis, since the course may rapidly be fatal in spite of all medical treatments. Ultrasonography mostly presents the advantage of detecting intrathyroid parathyroids glands. The experience of the surgeon is essential for the mandatory locating of 4 glands, and the choice of the surgical strategy. In front of a secondary indication for failure or recurrence, one must take into consideration what was seen and done during the first procedure, the calcemia levels and clinical, radiological or biological consequences. Finally, in case of cancer (2 p. cent), the best prognosis rests in wide excision of the thyroid compartment and nodes areas, since medical treatments and radiation therapy are ineffective.
mesh_terms: D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000097:blood; D006961:Hyperparathyroidism / Q000097:blood / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010279:Parathyroid Diseases / Q000150:complications* / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000150:complications* / Q000601:surgery; D012008:Recurrence; D012086:Reoperation
vernacular_title: La chirurgie des hyperparathyroïdies primitives en 1988. Stratégies lors des interventions premières, en cas d'échec et en cas de cancer.