title: Outcomes after subtotal parathyroidectomy for primary hyperparathyroidism due to hyperplasia: significance of whole vs. partial gland remnant.
abstract: BACKGROUND
  Primary hyperparathyroidism (PHPT) due to multigland hyperplasia is managed by subtotal parathyroidectomy (sPTX), with a partial gland left in situ. However, smaller, hyperplastic glands may be encountered intraoperatively, and it is unclear if leaving an intact gland is an equivalent alternative. This study evaluates the rates of permanent hypoparathyroidism and cure of PHPT patients with four-gland hyperplasia that were left with either a whole gland remnant (WGR) or a partial gland remnant (PGR) after sPTX.
  
  
  METHODS
  We reviewed the outcomes of PHPT patients with hyperplasia who underwent sPTX at an academic institution. Surgeon intraoperative judgment determined remnant size (a WGR vs. a PGR).
  
  
  RESULTS
  Between 2002 and 2013, 172 patients underwent sPTX for PHPT. There were 108 patients (62.8%) who had a WGR. Another 64 patients (37.2%) had a PGR. Mean age was 60 ± 14 years. There were 82.6% female patients. Cases with positive family history for PHPT were more likely to have a PGR (12.5 vs. 3.7%; p = 0.03). Patients had similar preoperative and postoperative laboratories. Individuals with a PGR tended to have larger glands encountered by surgeons intraoperatively (525 ± 1,308 vs. 280 ± 341 mg; p = 0.02). One patient with a WGR developed permanent hypocalcemia. Overall, the cure rate was 97.1%. A mean of 29 ± 28.7 months follow-up revealed a recurrence rate of 5.2%. Disease persistence and recurrence rates were similar in patients.
  
  
  CONCLUSIONS
  PHPT due to hyperplasia is managed by sPTX, leaving WGR without increased rates of disease persistence/recurrence. Patients without family history for hyperparathyroidism and those with smaller glands may be the best candidates for this approach.
authors.affiliation: Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Rajaei
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Oltmann
authors.forename: David F
authors.initials: DF
authors.lastname: Schneider
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000473:pathology* / Q000601:surgery; D006965:Hyperplasia / Q000097:blood / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000097:blood / Q000473:pathology* / Q000601:surgery; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D010281:Parathyroid Hormone