Controversy continues between bilateral neck exploration and limited parathyroidectomy guided by gland hyperfunction. While one approach depends on gland size and histopathology, the other limits excision to hypersecreting glands only. Although both methods claim early operative success, the late recurrence rate with limited exploration is unknown. Late biochemical outcomes from these two operative approaches are reported.
Some 301 consecutive patients with primary hyperparathyroidism were followed 6–495 months after successful parathyroidectomy; 164 patients had bilateral neck exploration with excision of enlarged glands (group 1) and 137 patients had glands excised based on hypersecretion (group 2). Calcium and intact parathyroid hormone (iPTH) levels were measured yearly. Recurrent parathyroid gland hypersecretion was determined by iPTH levels above the normal range.
In group 1, a single gland was excised in 150 patients (91 per cent); 15 (9 per cent) of 164 had late raised iPTH levels (12 normocalcaemic). In group 2, 133 patients (97 per cent) had a single gland excised and 21 (15 per cent) of 137 had high iPTH levels (19 normocalcaemic). The number of patients with more than one gland excised in group 1 (9 per cent) was three times higher than that in group 2 (3 per cent) (P < 0·04). There was no statistical difference in the incidence of recurrent hyperfunctioning glands between the two operative approaches (χ2 test).
Based on late parathyroid gland function, parathyroidectomy guided by gland hyperfunction yielded comparable results to bilateral neck exploration. Multiple gland excision based on gross appearance alone may result in unnecessary excision of normal glands and possible hypoparathyroidism. © 2000 British Journal of Surgery Society Ltd