Long-term follow-up after parathyroidectomy for radiation-induced hyperparathyroidism.
BACKGROUND
External radiation is associated with a risk of hyperparathyroidism. We reviewed the outcomes after operation for radiation-induced hyperparathyroidism (R-HPT).


METHODS
We conducted a retrospective review of all patients who had operative therapy for R-HPT from 1980 to 2003 in our department with a minimum of 3 years of follow-up after operative therapy.


RESULTS
Between 1980 and 2003, 1932 patients underwent parathyroidectomy for primary hyperparathyroidism. Thirty-seven (1.92%) patients had a history of neck irradiation. Thirty-two patients underwent a bilateral exploration (BE), and 5 patients had a focused approach (FA). Thirty-five patients presented with single gland disease, and 2 patients had multiple gland disease. In the BE group, 26 patients remained cured biochemically after a median follow-up of 10.3 years (range, 3-21 years), and 6 patients had recurrence after a median of 13.2 years (range, 7-22 years). In the FA group, all 5 patients remained cured biochemically; however, the median follow-up remained shorter (6.4 years; range, 3-8 years).


CONCLUSIONS
In R-HPT, the incidence of multiple gland disease at the time of initial operation was comparable with sporadic HPT. In the absence of thyroid disease, an FA may be proposed for R-HPT. Metachronous pathologic glands may develop several years after successful parathyroidectomy in R-HPT. Hence, lifelong follow-up of these patients is essential.
Ippolito
Giuseppe
G
Department of Endocrine Surgery, La Timone Hospital, Marseille, France.
Palazzo
F Fausto
FF
Sebag
Frederic
F
Henry
Jean François
JF
D000236:Adenoma / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D018761:Multiple Endocrine Neoplasia Type 1 / Q000532:radiotherapy; D018813:Multiple Endocrine Neoplasia Type 2a / Q000532:radiotherapy; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology / Q000601:surgery*; D010282:Parathyroid Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D016105:Parathyroidectomy; D012189:Retrospective Studies