A clinical evaluation of radiation‐induced hyperparathyroidism based on 148 surgically treated patients

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Abstract
During a 29‐year period ending in 1981, there were 839 patients treated surgically for hyperparathyroidism (HPT). One hundred and forty‐eight (17.6%) of these patients had a history of previous radiation to the neck region. Latency time between irradiation and diagnosis was inversely correlated to age at irradiation and showed a mean of 35 years. Hyperparathyroidism (HPT) following neck radiotherapy (r‐HPT) had the same clinical presentation as spontaneous primary HPT (p‐HPT); however, the r‐HPT patients traced by follow‐up had milder disease. In patients with r‐HPT or p‐HPT, kidney stones were more common in men, while mental and skeletal changes were more common in women. The percentage distribution of adenoma and chief‐cell hyperplasia did not differ between the two groups. There were no cases of water clear‐cell hyperplasia or parathyroid carcinoma among r‐HPT patients. Location of a parathyroid adenoma in an upper gland was significantly more common (p<0.001) in patients with r‐HPT compared to patients with p‐HPT. This distribution of adenomas could be correlated with the radiation treatment field. Concomitant thyroid abnormalities were diagnosed in 84% of patients with r‐HPT and in 49% of patients with p‐HPT. Thyroid carcinoma occurred 9 times more often in r‐HPT patients strengthening the indication for surgery in irradiated subjects.