Long-term results of surgery for lithium-associated hyperparathyroidism.
BACKGROUND
Lithium therapy for affective bipolar disease is frequently associated with hyperparathyroidism (HPT), but the results of surgical treatment are virtually unknown. The aim of this retrospective review was to analyse the long-term outcome after surgery for lithium-induced HPT in a large series of patients.


METHODS
Seventy-one patients on chronic lithium therapy who underwent surgery in three university and three district hospitals in Sweden were followed for a median of 6.3 years. Histopathology, complications of surgery and normocalcaemia at 6 months after surgery and last follow-up were analysed.


RESULTS
The primary histopathological diagnoses were adenoma (45 per cent), double adenomas (3 per cent) and hyperplasia (52 per cent). No permanent paresis of the recurrent laryngeal nerve was recorded but 13 per cent of the patients suffered from permanent hypoparathyroidism. At follow-up, the rate of persistent and recurrent HPT was 42 per cent regardless of the histopathological diagnosis.


CONCLUSIONS
The results of conventional surgery for lithium-associated HPT are poor. The surgical approach should be adjusted for the multiglandular disease that is usually the cause of HPT in patients on chronic lithium therapy.
Järhult
J
J
Department of Surgery, Höglandssjukhuset Eksjö, Eksjö, Sweden. johannes.jarhult@lj.se
Ander
S
S
Asking
B
B
Jansson
S
S
Meehan
A
A
Kristoffersson
A
A
Nordenström
J
J
D000236:Adenoma / Q000150:complications / Q000601:surgery*; D000368:Aged; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000139:chemically induced / Q000150:complications / Q000601:surgery*; D018020:Lithium Compounds / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000150:complications / Q000601:surgery*; D016105:Parathyroidectomy / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D013548:Sweden; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D018020:Lithium Compounds