Aim:

Primary hyperparathyroidism is an endocrine disease characterised by hypercalcemia due to increased parathormone (PTH) secretion. Treatment is surgical excision of pathologic glands by bilateral exploration of the parathyroid glands or focused parathyroidectomy. Our aim was to evaluate the results of patients who underwent parathyroid surgery for primary hyperparathyroidism.

Methods:

Patients, who underwent parathyroid surgery in our clinic between 2013 and 2017, were retrospectively evaluated. Data on demographic characteristics, preoperative PTH, calcium, phosphorus, albumin, and vitamin D levels, parathyroid scintigraphy or single photon emission computed tomography, and neck ultrasonography findings, additional investigations, surgical procedure, postoperative PTH and calcium levels, results of pathological investigations, complications, and persistence and recurrence rates were recorded. Patients with missing data and secondary hyperparathyroidism were excluded.

Results:

The median age of 59 patients was 56±11.2 years and the female-to-male ratio was 43/16 preoperative PTH level 272±171 ng/L and calcium level was 11.8±0.68 mg/dL. The median follow-up period was 22 (3-56) months. Ten patients (16.9%) were symptomatic, 49 (83.1%) were asymptomatic. 50.8 of the patients underwent focused parathyroidectomy, 1.7%—bilateral exploration, 18.6%—unilateral exploration. Eighteen-point-six percent underwent thyroid lobectomy and 10.2% underwent bilateral total thyroidectomy due to additional thyroid pathology. Thyroid lobectomy was performed in one patient because of suspicion of parathyroid cancer.

Conclusion:

The most important factors affecting the surgical success of primary hyperparathyroidism are the accurate diagnosis before surgery and to accurately identify the localization of the diseased parathyroid gland. Localization studies are carried out meticulously in our series and therefore surgical success is increasing.

Keywords: Primary hyperparathyroidism, hypercalcemia, focused parathyroidectomy, bilateral exploration