Recurrence after successful parathyroidectomy-Who should we worry about?

Abstract

BACKGROUND:

Preventing cervical reoperations is important-especially after parathyroidectomy. We sought to examine early predictors of recurrence of primary hyperparathyroidism after surgical cure.

METHODS:

Adult patients with sporadic primary hyperparathyroidism treated with parathyroidectomy between September 1, 1997, and September 1, 2019, with confirmed eucalcemia at 6 months postoperatively were identified. Recurrence was defined as hypercalcemia (>10.2 mg/dL) with an elevated or nonsuppressed parathyroid hormone level on subsequent follow-up.

RESULTS:

Parathyroidectomy was performed in 522 patients (median age, 62.1 years, 77% female) with the majority undergoing planned minimally invasive parathyroidectomy (85.4%, n = 446). After a median follow-up of 30.9 months, 13 patients (2.5%) recurred (median time to recurrence 50.2 months, interquartile range 27.9-66.5), all of whom underwent planned minimally invasive parathyroidectomy (n = 13/446, 2.9%). Recurrence was more common in those with higher (but still normal) 6-month calcium (10.1 vs 9.3 mg/dL, P < .001) or parathyroid hormone values (64 vs 46 pg/mL, P < .01). Multivariate analysis revealed that age >66.5 years, calcium ≥9.8mg/dL and parathyroid hormone ≥80 pg/mL at 6 months were associated with increased risk of recurrence. In addition, the presence of at least 1 preoperative imaging study that conflicted with intraoperative findings among minimally invasive parathyroidectomy patients (n = 446) was associated with increased risk of recurrence (hazard ratio 4.93, 95% confidence interval 1.25-16.53, P = .016).

CONCLUSION:

Recurrence of sporadic primary hyperparathyroidism after initial surgical cure in the era of minimally invasive parathyroidectomy is 2.5%. Identification of those at risk for recurrence using 6-month serum calcium ≥9.8 mg/dL, parathyroid hormone ≥80 pg/mL, and/or potentially conflicting localization studies may inform surveillance strategies.

• Authors: Aditya S Shirali, Si-Yuan Wu, Yi-Ju Chiang, Paul H Graham, Elizabeth G Grubbs, Jeffrey E Lee, Nancy D Perrier, Sarah B Fisher
• Journal: Surgery (Surgery) Vol. 171 Issue 1 Pg. 40-46 (01 2022) ISSN: 1532-7361 [Electronic] United States
• PMID: 34340820 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Chemical References

• Parathyroid Hormone
• Calcium

Topics

• Aged
• Calcium (blood)
• Female
• Follow-Up Studies
• Humans
• Hypercalcemia (blood, diagnosis, epidemiology, surgery)
• Hyperparathyroidism, Primary (blood, diagnosis, epidemiology, surgery)
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures (statistics & numerical data)
• Parathyroid Hormone (blood)
• Parathyroidectomy (methods, statistics & numerical data)
• Recurrence
• Retrospective Studies
• Risk Assessment (methods, statistics & numerical data)
• Treatment Outcome