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.
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Article info
Publication history
Published online: August 02, 2021
Accepted:
June 23,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
