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No recurrence of sporadic primary hyperparathyroidism when cure is established 6 months after parathyroidectomy

Departments of
¹ Endocrinology and Metabolic Diseases,
² Surgery
³ Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands

(Correspondence should be addressed to N A T Hamdy; Email: n.a.t.hamdy{at}lumc.nl)

Objective: Cure rate for primary hyperparathyroidism (PHPT) is reported to be 94–100% 1 year after surgery, but recent data suggest recurrence in 4% of the patients 1–5 years post-operatively. The aim of our study was to establish the cure rate and its maintenance in the long-term after parathyroidectomy (PTx) in patients with sporadic PHPT.

Design: Evaluation of recurrence in patients with sporadic hyperparathyroidism who underwent PTx 1–24 years prior to the study.

Patients and methods: We identified 111 patients who underwent initial PTx between 1984 and 2008, and had no MEN-1, MEN-2, or CaR mutation; parathyroid carcinoma; a history of lithium use; or renal failure. Thirty-eight patients were lost to follow-up or were unwilling or unable to participate in the study. Cure was defined as maintenance of normal serum calcium and parathyroid hormone concentrations 6 months after PTx.

Results: Cure was achieved in 68 of 73 patients studied (93%) and was sustained in all for 6±5 years.

Conclusion: The cure rate of sporadic PHPT after initial surgery is 93%. When cure is achieved, this is sustained in 100% of the patients for up to 24 years post-operatively. Our data suggest that closer early follow-up is advocated in all patients undergoing PTx to definitively establish cure and to provide a safety net for those with residual gland pathology. The data do not support the need for long-term follow-up when cure is established 6 months after PTx.