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Is parathyroidectomy safe and effective in patients with normocalcemic primary hyperparathyroidism?

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Indications and advantages of parathyroidectomy in patients with normocalcemic primary hyperparathyroidism (NHPT) are still matter of debate. We aimed to compare clinical presentation and surgical outcome between normocalcemic and hypercalcemic forms in a consecutive series of patients who underwent parathyroidectomy for primary hyperparathyroidism.


Data of 731 consecutive patients were reviewed and retrospectively compared according to normocalcemic (group A) and hypercalcemic (group B) phenotypes.


No significant differences were found between the two groups concerning demographics and symptomatic onset. Mean preoperative PTH levels were significantly higher in group B (252.0 ± 320.7 pg/ml vs 151.7 ± 112.0; p < 0.001). Mean PTH levels in first postoperative day were significantly lower in group B (30.9 ± 26.2 vs 22.7 ± 20.7; p < 0.001). No significant difference in overall accuracy of preoperative imaging studies was found. Significantly more patients in group A underwent bilateral explorations (83 vs 255; p < 0.05). The rate of multigland disease was significantly higher in group A (13.0 vs 6.8%; p < 0.05). At a mean follow-up period of 72.9 ± 46.8 months, all but three patients, among the 96 of group A who completed follow-up evaluation, were biochemically cured. The remaining patients had persistent high PTH values. Among NHPT patients who had target organ disease before parathyroidectomy, improvement in bone density and in kidney stones was observed in 41.7 and 40.0%, and stability in 50.0 and 60.0% respectively.


In normocalcemic patients, parathyroidectomy is as safe and effective as in hypercalcemic patients. In the presence of symptoms and/or target organ disease, parathyroidectomy may have a positive effect on the outcome of NHPT patients.

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The present study was in part supported by financial research contributions from the Università Cattolica del Sacro Cuore (Linea D1-2017, code R4124500587).

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Authors and Affiliations



Study conception and design: E Traini, M Raffaelli, CP Lombardi, and R Bellantone. Acquisition of the data: SE Tempera and S Russo. Analysis and interpretation of data: E Traini, M Raffaelli, C De Crea, and SE Tempera. Drafting of manuscript: E Traini, M Raffaelli, SE Tempera, and S Russo. Critical revision of manuscript: R Bellantone, CP Lombardi, and C De Crea.

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Correspondence to Marco Raffaelli.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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The authors declare that they have no conflict of interest.

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Traini, E., Bellantone, R., Tempera, S.E. et al. Is parathyroidectomy safe and effective in patients with normocalcemic primary hyperparathyroidism?. Langenbecks Arch Surg 403, 317–323 (2018).

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