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Results of surgery for sporadic primary hyperparathyroidism in patients with preoperatively negative sestamibi scintigraphy and ultrasound

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Abstract

Purpose

The purpose of this study is to investigate the results of first-time surgery for sporadic primary hyperparathyroidism (pHPT) in patients with preoperatively negative sestamibi scintigraphy and ultrasound.

Methods

Data were gathered prospectively in a multicenter database for quality control in parathyroid surgery. Between 2004 and 2008, 3,158 patients underwent first-time surgery for sporadic pHPT. A total of 984 patients were subjected to preoperative localization with ultrasound and sestamibi scintigraphy, and in 173 patients, both investigations were negative. Intraoperative findings and early outcome are reported.

Results

One hundred and fifty-five of 173 patients underwent bilateral neck exploration. The median weight of excised parathyroid tissue was 350 mg. In 23 patients (13.3%), the exploration was negative. A total of 112 patients (64.7%) had a histological diagnosis of parathyroid adenoma and 38 patients (22%) had multiglandular disease. Six weeks after operation, 164 patients were available for analysis, and 30 patients (18%) had persistent pHPT. The risk for persistent pHPT increased for patients with few intraoperatively identified (p = 0.001) and excised (p = 0.024) parathyroid glands. Patients operated with intraoperative parathyroid hormone (iOPTH) had lower risk for persistent pHPT 7/79 (9%) compared with 23/85 patients (27%) operated without iOPTH (p = 0.003).

Conclusions

Negative localization with sestamibi and ultrasound in pHPT infers a highly selected patient population with small parathyroid adenomas, an alarmingly high rate of negative exploration, and an increased risk for persistent disease. The use of iOPTH influences cure rate favorably.

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Acknowledgement

This study was supported by grants from:

The European Union (Interreg. IIIA)

The Swedish Board of Health and Social Welfare

The Swedish Association of Local Authorities and Regions

The following departments participated in this study:

Department of Surgery, Lund University Hospital

Department of Breast and Endocrine Surgery, Copenhagen University Hospital Rigshospitalet

Department of Surgery, Central Hospital, Kristianstad

Department of Surgery, Helsingborg Hospital

Department of Surgery, University Hospital of Uppsala

Center for Metabolism and Endocrinology, Karolinska University Hospital-Huddinge

Department of Surgery, Central Hospital, Halmstad

Department of Surgery, Falu Hospital

Department of Surgery, Växjö Central Hospital

Department of Surgery, Västerås Central Hospital

Department of Surgery, Södersjukhuset

Department of Surgery, Karolinska University Hospital

Department of Surgery, Sunderby Hospital

Department of Surgery and Transplantation, Sahlgrenska University Hospital

Department of Surgery, Nyköping Hospital

Department of Surgery, University Hospital of Umeå

Center for Endocrine Neck Surgery, ENT Department F, Odense University Hospital

Department of Surgery, Norra Älvsborgs Länssjukhus

Department of Surgery, Jönköping Hospital Ryhov

Department of Surgery, Åhus University Hospital

Department of Surgery, Karlstad Central Hospital

Department of Surgery, Sundsvall Hospital

Department of Surgery, Kungälv Hospital

Conflicts of interest

None.

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Authors and Affiliations

Authors

Corresponding author

Correspondence to Anders O. J. Bergenfelz.

Additional information

All authors are members of the Steering Committee of the Scandinavian Quality Register for Thyroid and Parathyroid Surgery (www.thyroid-parathyroidsurgery.com).

Authors’ contribution

The study conception and design were made by Anders O. J. Bergenfelz, Göran Wallin, Svante Jansson, Håkan Eriksson, Hans Mårtensson, Peer Christiansen, and Eva Reihnér.

Acquisition of data was done by Anders O. J. Bergenfelz, Göran Wallin, Svante Jansson, Håkan Eriksson, Hans Mårtensson, Peer Christiansen, and Eva Reihnér.

Analysis and interpretation of data were made by Anders O. J. Bergenfelz.

Drafting of the manuscript was done by Anders O. J. Bergenfelz.

Critical revision of the manuscript was done by Anders O. J. Bergenfelz, Göran Wallin, Svante Jansson, Håkan Eriksson, Hans Mårtensson, Peer Christiansen, and Eva Reihnér.

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Bergenfelz, A.O.J., Wallin, G., Jansson, S. et al. Results of surgery for sporadic primary hyperparathyroidism in patients with preoperatively negative sestamibi scintigraphy and ultrasound. Langenbecks Arch Surg 396, 83–90 (2011). https://doi.org/10.1007/s00423-010-0724-0

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  • DOI: https://doi.org/10.1007/s00423-010-0724-0

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