Endocrine Abstracts

Introduction: Parathyroidectomy is performed in primary hyperparathyroidism using either focussed approach or bilateral neck exploration depending upon the pre-operative localisation results. The type of localising investigations and utility of intra-operative adjuncts like IOPTH vary in individual units. In our unit, parathyroid sestamibi scan and neck ultrasound (USS) are done routinely for all cases, and SPECT/CT and CT or MRI are reserved for selective patients. This study looks into our practice to evaluate our first-time success rate and eventual cure rate.

Methods: All consecutive patients who underwent parathyroidectomy for primary hyperparathyroidism between January 2009 and October 2011 were reviewed. 10 patients who had intra-operative sestamibi injection with gamma probe guidance and IOPTH were excluded.

Results: Out of 150 (Male/Female: 42/108) patients, 67 had focussed parathyroidectomy and 83 had bilateral neck exploration. Median age was 64 years (range 22–86). All 150 had sestamibi scan and 147 had USS (one had CT neck, one had SPECT/CT and one had none) with concordance in 69 cases (46%). The median duration of operation was 34 minutes (range 8–126).

The serum calcium level was normal in 142 patients at follow-up (first time success rate 94.7%). Out of the remaining 8 patients (2 focussed and 6 bilateral exploration), 5 had re-exploration and were cured, 3 did not have further operation (2 are awaiting further investigations for MEN1, 1 patient has normal calcium and is being actively monitored). Histology showed single adenoma in 137 cases, 2 double adenomas, 6 multi-glandular hyperplasia, 3 normal parathyroid gland, 1 thyroid colloid nodule and 1 thymic tissue. The eventual cure rate was 98% pending three patients who have not had re-operation yet.

Conclusion: Parathyroidectomy for primary hyperparathyroidism can be safely performed with acceptable cure rates reserving the costly and time-consuming intra-operative adjuncts for cases with difficult preoperative localisation.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.