RESEARCH – December 2014

Retrospective study of surgical treatment of primary hyperparathyroidism at Tartu University Hospital

Authors: Ceith Nikkolo, Sten Saar, Maksim Sokirjanski, Liina-Kadi Junkin, Urmas Lepner

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Background. Primary hyperparathyroidism (pHPT) is a benign disease which can increase the risk of malignancy and cardiovascular diseases if left untreated (1–4). The incidence of pHPT is 100–300:100 000 (5). In 76–89% of cases the cause of pHPT is an over-production of parathyroid hormoone (PTH) by a single parathyroid gland, which usually results in hypercalcaemia. The aim of this study was to evaluate the results of surgical treatment of pHPT at Tartu University Hospital.

Methods. A retrospective study based on the cases of pHPT treated in 2009–2013 at the Surgery Clinic of Tartu University Hospital.

Results. A total of 78 patients were treated with primary operation due to pHPT between 2009 and 2013 at the Surgery Clinic of Tartu University Hospital. In 40% of the patients it was an incidental finding. The value of preoperative mean ionized calcium (iCa) was 1.57 mmol/l and the mean PTH value was 44.35 pmol/l. Preoperative ultrasound was performed in 76% of the cases and Tc-99m sestamibi scintigraphy in 72% of the cases. A focused operation was used in 16 parathyroidectomy cases. The mean iCa value was 1.26 mmol/ l on the first postoperative day. In 83% of the cases the finding of a single adenoma was histologically confirmed. According to the electronic health record system eHL, implemented at Tartu University Hospital, and postoperative follow-up telephone interviews, 90% of the patients (n = 59) achieved complete recovery. There was no follow-up data of recovery in 19 cases.

Conclusions. Considering the incidence of pHPT the rate of surgical treatment should be higher in Estonia. It is necessary to improve the aspects of preoperative diagnostics, choice of the operation method and postoperative follow-up of patients. Given the lack of consensus on the treatment of the disease worldwide with an incomparably larger number of patients, it is difficult to make relevant definite conclusions on the basis of patients with pHPT in Estonia.

According to literature data, focused parathyroidectomy does not have considerable advantages over bilateral exploration. Although speculatively the usage of bilateraal exploration without pre- and intraoperative localization investigations may result in lower costs compared with the focused approach, bilateral exploration could be the preferred approach of treatment of pHPT.