Tertiary hyperparathyroidism: is less than a subtotal resection ever appropriate? A study of long-term outcomes.
BACKGROUND
Our aim was to examine the outcomes of patients with tertiary hyperparathyroidism (3-HPT) who had limited resection of 1 or 2 parathyroids.


METHODS
We reviewed 140 patients with 3-HPT who underwent parathyroidectomy (PTX) at a single institution. Patients were analyzed according to their operation-limited PTX versus subtotal or total PTX.


RESULTS
The limited PTX group consisted of 29 patients who underwent resection of 1 (n = 12) or 2 (n = 17) parathyroids. The other 111 patients had subtotal (n = 104), total (n = 3), and/or reoperative PTX (n = 12). The mean +/- SEM follow-up was 79 +/- 5 months. Eucalcemia was achieved in 94% of the patients. All patients with persistent (n = 2) hypercalcemia underwent subtotal PTX (P = not significant [NS] vs limited PTX). In a logistic regression model, the extent of operation was not associated with the development of recurrent disease. Additionally, the incidence of permanent hypocalcemia was 7% after subtotal or total PTX versus 0% after limited resection (P = NS).


CONCLUSIONS
Long-term outcomes in patients with 3-HPT appear to be similar after appropriate limited resection of 1 or 2 parathyroid glands compared to subtotal or total PTX. Therefore, a strategy of limited parathyroid resection seems appropriate for patients with 3-HPT when the disease is limited to 1 or 2 glands.
Pitt
Susan C
SC
Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, Madison, WI 53792-3284, USA.
Panneerselvan
Rajarajan
R
Chen
Herbert
H
Sippel
Rebecca S
RS
D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000601:surgery; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D006996:Hypocalcemia / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000378:metabolism; D016105:Parathyroidectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D010281:Parathyroid Hormone; D002118:Calcium