Predictors of Outcomes of Parathyroidectomy for Primary Hyperparathyroidism: A Retrospective Observational Study.

Document Type : Original Article

Authors

1 Department of General and Oncology Surgery, Faculty of Medicine, New Valley University

2 Department of General and Oncology Surgery, Faculty of Medicine, Assiut University

3 Department of General and Oncology Surgery, Faculty of Medicine, Benha University

4 Department of Clinicl Pathology, Faculty of Medicine, New Valley University

Abstract

Introduction: Parathyroidectomy (PTX) is highly effective in treating PHPT. It leads to decreased serum PTH
and equalizes calcium/phosphate homeostasis, reduces inflammatory-cardiovascular risk, and improves diastolic
and systolic functions within the first-month post-surgery. Moreover, PTX significantly decreased the prevalence
of anemia in PHPT patients six months after surgery. Furthermore, PHPT worsens sleeping patterns, but PTX
improved the patient’s mood and sleep patterns with more deep sleep and fewer nighttime awakenings.
Aim of work: This retrospective study aimed to define the surgical and biochemical outcomes of parathyroidectomy
for patients with primary hyperparathyroidism (PHPT) and to identify potential predictors for these outcomes.
Patients and methods: Twenty-nine files of patients who underwent parathyroidectomy for PHPT were analyzed.
Preoperative demographic, clinical, radiologic, and biochemical data were collected. Intraoperative (IO) and
postoperative (PO) data were gathered. The percentage of PO changes in serum parathormone (PTH) and calcium
and the frequency of PO normalization of PTH were evaluated.
Results: Six files (20.8%) indicated normocalcemia, while 23 showed hypercalcemia. Nine patients had recurrent
urolithiasis with significantly higher frequency among normocalcemic patients. Postoperative serum PTH levels
decreased significantly, and all patients became normocalcemic. PO serum PTH and calcium levels were reduced
by ≥50% in 72.4% and by ≥25% in 62.1% of samples, respectively with significant differences in favor of
hypercalcemics. Patients were managed as one-day cases after assurance of competence in hemodynamic and
respiratory functions. PO complications were identified in 5 files (17.2%) and superficial wound infection is the
commonest. The correlation analysis detected a positive significant relationship between preoperative parathyroid
volume and preoperative serum PTH and calcium levels, normocalcemia, PO percentage of change in serum PTH
and calcium, and the normalization of serum PTH.
Conclusion: This retrospective data analysis confirmed the safety and effectiveness of parathyroidectomy for
PHPT patients and supports its feasibility as a one-day procedure. Preoperative assessment of gland volume is
crucial for surgical planning and aids in predicting PO biochemical outcomes. Preoperative normocalcemia did not
influence surgical outcomes, despite being associated with a higher incidence of urolithiasis.

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