PRIMARY HYPERPARATHYROIDISM - SURGICAL RESULTS OF 147 CONSECUTIVE PATIENTS

Surgery has been used to treat primary hyperparathyroidism since 1925. The indications for surgery in mild hypercalcaemia and in asymptomati c patients are not clearly established, but the attitude to surgery is liberal if the surgical results are good. The value of preoperative l ocalisation studies prior to the initial neck exploration is also ques tionable. We evaluated the results of 147 consecutive patients, who ha d been operated on for hyperparathyroidism. We analysed also the resul ts of preoperative localisation studies. Most of the patients had symp toms which could be related to primary hyperparathyroidism. Hypercalca emia was cured by surgery in 96 % of the patients, but six patients ne eded more than one procedure. Permanent hypocalcaemia ensued in 3 % of the patients. Complications were rare, but occurred more often in pat ients with previous thyroid or parathyroid operations, and in patients who needed a simultaneous thyroid operation. Preoperative ultrasonogr aphy, which was made in 135 patients, revealed an abnormal parathyroid gland correctly in 47 % of the patients. The result was incorrect in 26 % and there was no finding in 27 % of the patients. Thallium-techne tium subtraction scintigraphy, which was made in 96 patients, was corr ect in 29 incorrect 41 %, and uninformative in 30 % of the patients. A ngiography was performed in eight patients with a correct finding in s ix patients. We conclude that operative treatment for primary hyperpar athyroidism is successful and safe in experienced hands. The reliabili ty of noninvasive localisation studies is poor, and they are not neces sary before the initial neck explorations.