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23-03-2006 | Thyroid | Article

Subtotal parathyroidectomy appropriate for recurrent HPT

Abstract

Free abstract

European researchers have found that, when correctly performed, subtotal parathyroidectomy (SP) minimizes the risk of permanent hypocalcemia and facilitates further surgery in patients with recurrent hyperparathyroidism (HPT).

Reporting in the Archives of Surgery, Johnathan Hubbard, from St Thomas' Hospital in London, UK, and co-workers explain that "the most appropriate surgical approach for HPT in multiple endocrine neoplasia type 1 remains controversial."

To investigate this issue, the team recorded surgical outcomes for recurrent HPT in 29 patients. Of these, 21 received SP, four received total parathyroidectomy (TP), and less-than-subtotal parathyroidectomy was performed in the remainder.

After an average follow-up period of 7 years and 4.5 months, no patients had persistent HPT. However, four patients had died, with two of these deaths related to multiple endocrine neoplasia.

Temporary hypocalcemia was observed in 12 (57%) SP patients and in four (100%) individuals who received TP with autotransplantation, but in none of the less-than-subtotal parathyroidectomy patients.

Moreover, permanent hypocalcemia that required long-term treatment occurred in two (10%) individuals with SP and one (25%) individual who received TP with autotransplantation.

Recurrent disease developed in one patient who received SP, two with TP with autotransplantation, and in one who underwent less-than-subtotal parathyroidectomy, at 57, 197, and 180 months, respectively.

"Recurrent HPT occurs many years after definitive primary surgery (median, 14.3 years). Surgical treatment should therefore aim to minimize the risk of permanent hypocalcemia and facilitate future surgery," Hubbard and colleagues state.

"When correctly performed, SP fulfills these objectives."