Background:
Primary hyperparathyroidism (PHPT) is caused by autonomous overproduction of parathyroid hormone (PTH) from one or more parathyroid glands. Surgical excision, with either a focused parathyroidectomy or a 4-gland exploration is the treatment. Recurrence rates of sporadic PHPT ranges from 1.6-14.8%. However, between 4-40% have elevated parathyroid hormone (ePTH) with normal serum calcium levels post-operatively. The aim of this study was to assess ePTH and recurrent hypercalcaemia in patients undergoing parathyroid surgery for PHPT in our institution.
Methods:
A retrospective review of all patients who underwent parathyroidectomy in our institution from 2010 to 2023 was undertaken. Clinicopathologic data was collected from the prospectively maintained parathyroid and thyroid database.
Results:
137 of 217 patients who underwent parathyroidectomy during this period were included in this study, 32 male and 105 female. Patients were followed for one year after surgery. 42.7% of patients were found to have ePTH over this time, with no patients developing hypercalcaemia. Factors associated with elevated postoperative PTH included higher preoperative and postoperative day 1 PTH values.
Conclusion:
ePTH is commonly seen post-operatively among patients undergoing parathyroidectomy for PHPT. It remains poorly understood and is likely multifactorial in etiology. While it has been associated with a higher recurrence rate of hyperparathyroidism, our study suggests most patients with achieve long-term eucalcaemia.
Lee Peeperkorn1, Nicholas O’Keeffe1, Eoin Mooney1, Patrick Sheahan1,2
1 Department of Otolaryngology, Head & Neck Surgery, South Infirmary Victoria University Hospital, Cork
2 ENTO Research Unit, College of Medicine and Health, University College Cork, Cork