Burak IŞIK, Fatih GÖNÜLTAŞ

Parathyroidectomy for primary hyperparathyroidism: The results of a single institution

Aim: Prımary hyperparathyroidism (PHPT) is a clinical entity characterized by an excess synthesis of parathormone due to one ormore autonomic parathyroid gland. The present study aims to evaluate the outcomes of parathyroidectomies performed due toPHPT.Material and Methods: The results of 52 parathyroidectomies performed due to PHPT between September 2014 and October 2018were retrospectively evaluated for demographic, clinical, imaging and pathologic characteristics.Results: Fifty-two patients with primary hyperparathyroidism were included in the study. The mean age of the patients was50±14.5 years. Forty-three (82.9%) patients were female and 9 (17.4%) were male. The most common complaints at admissionwere generalized muscle and bone pain in 13 patients (15.3%). In 2 patients (3.8%) osteoporosis and another 2 (3.8%) patients,nephrolithiasis was identified. Thirty- five (67.3%) patients had no complaints. The mean preoperative calcium level was 11.21±0.88mg/dl. Mean preoperative phosphate level was 2.58±0.72 mg/ dl. Mean preoperative parathormone level was 278.65±317.67 pg/ml.Technetium 99m-sestamibi scintigraphy was obtained for 41 patients. Cervical ultrasonography was performed in 43 patients. Thesurgical localization of the parathyroid adenoma showed that the accuracy of ultrasonography was 60.4% whereas the accuracyof Technetium 99m-sestamibi scintigraphy was 80.4%. Three of the 12 (25%) patients with no localization in ultrasonography hadparathyroid hyperplasia as the pathologic diagnosis. There were two patients in whom ultrasonography and scintigraphy couldnot localize the pathologic parathyroid tissue and all of them (100%) were found to have parathyroid hyperplasia as the pathologicevaluation. Pathologic evaluation of the surgical specimens showed that there was adenoma in 40 patients (76.9%), hyperplasiain 5 (9.6%), normal parathyroid tissue in 5 (9.6%), tumor with undetermined biologic potential in 1 patient (1.9%) and adenomatousparathyroid tissue in 1 patient (1.9%). In fifteen patients (28.8%) concomitant total thyroidectomy, right lobectomy in 7 patients(13.4%)and left lobectomy in 4 patients (7.6%) were performed.Conclusion: Parathyroid adenoma can be localized in places other than the expected locations; despite the advances in imagingtechnologies. Surgeons experience and accurate localization before the operation are important for a successful parathyroidoperation. If scintigraphy and ultrasonography cannot localize the pathologic parathyroid tissue, hyperplasia should be suspected.

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