Results of Reoperation for No. 6 Persistent and Recurrent Hyperpara thyroidism

Abstract

Between Aug. 1975 and Jan. 1981, 106 patients thought to have persistent or recurrent hyperparathyroidism underwent a total of 108 parathyroid re-explorations at the National Institutes of Health. These 106 patients had a total of 175 previous operations for hyperparathyroidism (156 cervical and 19 mediastinal). Nephrolithiasis (54% of patients) and bone disease (24% of patients) were the predominant symptoms. Arteriographic examination and selective venous sampling provided highly accurate localizing results in 33% of the patients, and were of some help in 64%. The final diagnoses after reoperation and re-evaluation were: single-gland disease in 58 patients, primary non-familial hyperplasia in 19 patients, familial hyperplasia in 3 patients, multiple endocrine neoplasia (MEN) Type I in 10 patients, MEN Type II in 2, parathyroid carcinoma in 4 patients, secondary hyperplasia in 3 patients, and familial hypocalciuric hypercalcemia (FHH) in 2 patients. The diagnosis was in doublt in 5 patients. In the 95 patients with unequivocal hyperparathyrodism, not due to parathyroid carcinoma, surgery eliminated hypercalcemia in 91 (96%). Two patients died after operation, 1 of disseminated candidiasis, and 1 patient, with an immunodeficiency, of sepsis. Five patients developed temporary, and 1 permanent, recurrent nerve damage; 41% of the patients were hypocalcemic, at the time of discharge from the hospital.