Long-term management and outcome of parathyroidectomy for sporadic primarymultiple-gland disease

Hypothesis: For a specific subset of patients with sporadic primary multipl e-gland parathyroid disease, subtotal parathyroidectomy results in long-ter m normocalcemia in the majority of patients, with a minimal complication ra te. Design: Retrospective analysis of outcomes in patients undergoing parathyro idectomy performed by a single surgeon (A.E.G.) between 1984 and 1999. Setting: A multidisciplinary endocrine service based at a tertiary referral center. Patients: Patients undergoing subtotal parathyroidectomy for primary hyperp arathyroidism due to sporadic multiple-gland disease identified from a sing le surgeon's operative records (A.E.G.). Main Outcome Measures: Data analyzed included demographic factors, operativ e and pathologic findings, and postoperative and long-term clinical and lab oratory results, including calcium and intact parathyroid hormone levels. Results: Of 379 patients undergoing parathyroidectomy for hyperparathyroidi sm between 1984 and 1999, 49 (13%) had sporadic multiple-gland disease. Med ian preoperative calcium and intact parathyroid hormone (iPTH) levels were 2.7 mmol/L (10.8 mg/dL) and 11.79 pmol/L, respectively. Postoperative calci um and iPTH levels were available in 39 patients, and median values were 2. 28 mmol/L (9.1 mg/dL) and 2.84 pmol/L, respectively. Long-term follow-up wa s available for 36 patients (73%), and duration ranged from 6 to 180 months (median, 44 months). Median calcium and iPTH levels at follow-up were 2.3 mmol/L (9.2 mg/dL) and 3.26 pmol/L, respectively, with 3 (8%) of 36 patient s having evidence of persistent or recurrent hyperparathyroidism. No patien t had biochemical evidence of hypoparathyroidism at long-term follow-up. Fi ve patients (14%) had persistent elevated iPTH levels (range, 8.11-10.95 pm ol/L) and normal calcium levels. Conclusions: Subtotal parathyroidectomy for sporadic primary multiple-gland disease resulted in a long-term normocalcemia rate of 92%, with minimal co mplications. Selective subtotal parathyroidectomy can yield excellent long- term results in patients with multiple-gland disease.