Surgical Management of Hyperparathyroidism Due to Primary Hyperplasia

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Abstract
A series of 104 consecutive patients treated at the Massachusetts General Hospital [USA] between 1933 and 1978 for primary parathyroid hyperplasia was reviewed. Early in this period (1933-1958) 9 patients were treated by what was then considered subtotal resection (5 with clear cell and 4 with chief cell hyperplasia). Hypercalcemia persisted in 4 cases; 3 from inadequate resection and 1 (case 170) associated with a 5th gland in the mediastinum that was removed at a 2nd stage operation. Later (1959-1978), adequate subtotal resection, leaving 30-50 mg of viable hyperplastic tissue, was performed in 28 patients (7 with clear cell and 21 with chief cell hyperplasia). The operation was successful in 27 patients (96%). In 1 patient (case 442) subtotal resection failed, and hypercalcemia recurred, requiring a 2nd operation. Sixty-seven patients in this series had excision of 1, 2, or 3 (but not more than 3) glands. Of these, 21 (31%) had persistent hypercalcemia after operation and required further surgery. Transient hypocalcemia occurred in 40 patients, permanent hypocalcemia in two. This study shows that subtotal resection, leaving 30-50 mg of viable tissue, is the surgical treatment of choice for primary parathyroid hyperplasia. It is effective in the great majority of patients. Total parathyroidectomy with autotransplantation was not found to be necessary; it should be reserved only for selected cases.