Endocrine Abstracts

Aims: To define and identify patients who have ‘failed’ parathyroidectomy by a single surgeon. To explore common features of these cases to refine our pathways.

Methods: This case note review began with a retrospective audit of 123 patients having neck exploration from January 2009 to May 2014. The dataset of clinicopathological information obtained from the electronic Trust records, was interrogated to identify patients fulfilling the following: Operations resulting in normal or no tissue removed; operations in which parathyroid adenoma was identified but with calcium on day 1 then close to 6 months remaining >2.6 mmol/l. Statistical differences between ‘successful’ and ‘failed’ distributions were examined with a Mann–Whitney U test and themes were explored using case notes.

Results: Only 13 of the 123 patients demonstrated normal histology and despite significantly higher post-operative calcium in this group, only seven remained hypercalcaemic at 6 months. In the complete cohort, day 1 calcium in those with positive histology was slow to correct in 15 patients, but only two patients had lasting hypercalcaemia. The biochemical diagnosis of primary hyperparathyroidism was secure in six out of the seven patients with normal histology, with one other altering course post-operatively. Although they didn’t all have urine CCCR, there was no statistical difference in this or pre-operative PTH for this group. Although only two were symptomatic of hypercalcaemia this was not unusual for the whole dataset, and all fulfilled at least one indication for parathyroidectomy as per the 2008 Third International Workshop. Most striking although not statistically significant was that four of this group didn’t have any positive imaging.

Conclusions: Post-operatively the diagnoses of the ‘failed’ parathyroidectomy patients were reviewed to be sound. Management revolved around a sestamibi scan, which when showing new findings led to repeat surgery. Those without repeat positive imaging are still a clinical dilemma.