Progress has been made

For those of us dealing with malignancy, it is sometimes hard to identify real progress. However, for persistent and recurrent hyperparathyroidism, what a difference 25 years makes! Twenty-five years ago, we reported an experience with 175 patients undergoing reoperation for persistent or recurrent hyperparathyroidism. One hundred and seventy-nine reoperations were performed on patients who had previously undergone 264 prior cervical or mediastinal explorations before being referred. This included 27 patients (15%) who had 3 or more cervical procedures and one or more mediastinal procedures. The patients were all symptomatic, often with severe bone and renal disease. Almost one third had multi-gland disease, 3% had carcinoma, and multiple localization studies were investigated prior to the availability of current noninvasive quality CT, MRI, and sestamibi scanning. Invasive studies were utilized including arteriography and venous sampling and less than half of those studies were accurate. Aspiration of the parathyroid was in its infancy. An intra-operative urinary cyclic AMP was the guide to successful completion in the absence of intra-operative parathyroid hormone assay. There was a 6% recurrent nerve injury rate with 41% having had, in addition to their prior exploration, some form of thyroidectomy. The patients had significant comorbidities and there were 2 deaths, 1 in a patient in parathyroid coma from candida endocarditis and another from staphylococcal sepsis in the presence of profound leukopenia. Thirty to forty percent required supplementary vitamin D and/or calcium for at least 6 months following successful operation, and one third of those who left the hospital on calcium and vitamin D received parathyroid autografts, initially fresh, but the majority cryo-preserved. ^,