Is focused parathyroidectomy appropriate for patients with primary hyperparathyroidism?
OBJECTIVE
The aim of this study was to determine whether focused or complete parathyroidectomy was more appropriate and to compare follow-up data in primary hyperparathyroidism (PHPT).


METHODS
We retrospectively analyzed 225 operations for PHPT at Yonsei University Health System between 2000 and 2012. After excluding 93 patients, the remaining 132 were divided into 2 groups: those who underwent focused parathyroidectomy (FP) and those who underwent conventional parathyroidectomy (CP). We compared clinicopathological features; preoperative calcium, parathyroid hormone (PTH), phosphorus, vitamin D, 24-hour urine calcium, and alkaline phosphatase levels; postoperative calcium and PTH levels; pathologic diagnosis; multiplicity; and results of a localization study between the 2 groups.


RESULTS
There was no significant difference in the rates of development of postoperative persistent hyperparathyroidism (1/122 FP patients and 1/10 CP patients) between the 2 groups due to a technical reason (FP 0.8% vs. CP 10.0%, P = 0.146). Multiglandular disease (MGD) was uncommon in all cases (6 of 132, 4.5%). All MGD cases were diagnosed using a preoperative localization study. Sestamibi scan and ultrasonography sensitivity were 94.2% and 90.2%, respectively.


CONCLUSIONS
We suggest that FP is appropriate in PHPT, except in cases of MGD if detected before the operation using preoperative imaging. Knowledge of hereditary PHPT and improved preoperative localization studies, such as high-resolution ultrasonography, contributed to the decision to perform FP rather than CP in all cases of unilateral results of the localizing study.
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Won Woong
WW
Kim
Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Yumie
Y
Rhee
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Eun Jeong
EJ
Ban
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Cho Rok
CR
Lee
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Sang-Wook
SW
Kang
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Jong Ju
JJ
Jeong
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Kee-Hyun
KH
Nam
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Woong Youn
WY
Chung
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Cheong Soo
CS
Park
Parathyroidectomy; Primary hyperparathyroidism; Technetium Tc 99m Sestamibi; Ultrasonography