Cure rate

Primary hyperparathyroidism can be cured with an operation, though cure rates will vary somewhat by surgeon and operative technique. Multiple factors contribute to the cure rates. Secondary hyperparathyroidism is primarily controlled medically.

During parathyroid surgery for primary hyperparathyroidism (high calcium preoperatively), I was found to have hyperplasia. My calcium is now normal but I have read that patients with hyperplasia have a higher chance of developing recurrent disease. What are the chances that I will get this again?

Parathyroid hyperplasia in primary hyperparathyroidism is interesting. Adenomas are straightforward: one "bad" gland is removed, and the normal ones are left behind to act normal. With hyperplasia, all four glands are involved, by definition. There are no completely normal glands. This is why we have to remove 3.5 glands, to debulk the parathyroids. In most cases, this produces a long-term cure...

Hyperplasia Primary HPT Secondary HPT Cure rate

Why do you look at all four parathyroid glands during the operation? Doesn’t that pose a risk to the glands?

Seeing all four parathyroid glands is the best way to ensure that you are removing all of the diseased glands and leaving in normal ones. However, there can be a risk: when you look at all four parathyroid glands (or even attempt to look at all four parathyroid glands), you are creating scar tissue, which could then make future operations more difficult. There is even a risk that during the dis...

Operation Primary HPT Operative technique Cure rate

Why don’t you use intraoperative PTH? Another surgeon I saw said that he uses intraoperative PTH (ioPTH) to confirm that the patient is cured. You said that you do not use ioPTH. Why is that?

I prefer to evaluate all four parathyroid glands rather than rely on intraoperative PTH. Here is why: intraoperative PTH is just not that accurate. Here is the thinking behind ioPTH: a surgeon can remove one parathyroid, often one seen on preoperative imaging, test the PTH level in the blood, then wait 5 to 10 minutes and test again, then wait 5 or 10 more minutes and test again. If the PTH dr...

Operation Operative technique Cure rate Intraoperative PTH