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Feasibility of unilateral parathyroidectomy in patients with primary hyperparathyroidism and negative or discordant localization studies

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Abstract

The purpose of this study was to examine the feasibility of unilateral parathyroidectomy in patients with primary hyperparathyroidism and negative or discordant localization studies. We included in our study 72 patients with preoperative diagnosis of primary hyperparathyroidism who had negative or discordant preoperative studies. In 66 patients, studies were discordant while in six were both negative. In 40 (55.6 %) patients initial approach was a bilateral exploration. In 32 cases (44.4 %) initial surgery was a unilateral exploration: in 26 conservative approach was successful, in six mini-invasive surgery failed and a bilateral exploration was necessary due to IOPTH negative test (five cases) or to the impossibility to find a pathological gland during exploration (one case). Intra-operative PTH test showed a sensitivity of 93.2 %, a specificity of 92.3 %, and an accuracy of 93.1 %. Multiple gland disease was found in 8 (11.1 %) patients (two double adenoma and six multiple gland hyperplasia). Mean operative time was lower in unilateral exploration group (87.9 ± 43.8 min). Comparing unilateral surgery in negative or discordant studies with 77 consecutive patients who underwent focused surgery with positive and concordant studies, conversion to bilateral exploration rate was statistically significantly higher in the first group (15.6 %). We believe that unilateral parathyroidectomy can be safely performed also in patients with discordant localization studies with a high cure rate; in these cases, however, the use of intra-operative PTH is absolutely necessary. We suggest the need for referral of these patients to high-volume medical centers for thyroid and parathyroid surgery.

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Abbreviations

PHP:

Primary hyperparathyroidism

US:

Ultrasound

MIBI:

Sestamibi scintigraphy

PTH:

Parathyroid hormone

IOPTH:

Intra-operative PTH

HPT:

Hyperparathyroidism

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Author contribution

PGC: study conception and design, analysis and interpretation of the data, drafting and critical revision of manuscript. FM: study conception and design, acquisition of data, analysis and interpretation of the data, drafting of manuscript. GL: acquisition of data. FP: acquisition of data. EE: analysis and interpretation of the data. GP: critical revision of manuscript. AN: critical revision of manuscript.

Acknowledgments

We thank Lucia Barca and Francesco Podda who provided IOPTH determination.

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Authors and Affiliations

  1. Department of Surgical Sciences, University of Cagliari, S.S. 554, Bivio Sestu, Monserrato, 09042, Cagliari CA, Italy

    Pietro Giorgio Calò, Fabio Medas, Giulia Loi, Enrico Erdas, Giuseppe Pisano & Angelo Nicolosi

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  1. Pietro Giorgio Calò
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  2. Fabio Medas
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  3. Giulia Loi
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  4. Enrico Erdas
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  5. Giuseppe Pisano
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  6. Angelo Nicolosi
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Corresponding author

Correspondence to Pietro Giorgio Calò.

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The authors declare that they have no conflict of interest.

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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.

Research involving human participants and/or animals

This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Calò, P.G., Medas, F., Loi, G. et al. Feasibility of unilateral parathyroidectomy in patients with primary hyperparathyroidism and negative or discordant localization studies. Updates Surg 68, 155–161 (2016). https://doi.org/10.1007/s13304-015-0342-z

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  • DOI: https://doi.org/10.1007/s13304-015-0342-z

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