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VOLUME 16 , ISSUE 2 ( May-August, 2024 ) > List of Articles

ORIGINAL RESEARCH

Focused Parathyroidectomy in Primary Hyperparathyroidism: Experience in a Tertiary Care Center of North India

Satyajit Kundu, Vivek Aggarwal, Ajay Aggarwal, Monika Garg

Keywords : Concordant imaging, Focused parathyroidectomy, Hungry bone syndrome, IOPTH monitoring, Primary hyperparathyroidism

Citation Information : Kundu S, Aggarwal V, Aggarwal A, Garg M. Focused Parathyroidectomy in Primary Hyperparathyroidism: Experience in a Tertiary Care Center of North India. World J Endoc Surg 2024; 16 (2):36-41.

DOI: 10.5005/jp-journals-10002-1476

License: CC BY-NC 4.0

Published Online: 06-03-2025

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: Primary hyperparathyroidism (PHPT) is an endocrine disorder characterized by dysregulated calcium homeostasis. Currently, there is a growing trend toward diagnosis via routine biochemical screenings. Surgery remains the only curative treatment, with minimally invasive techniques like focused parathyroidectomy (FP) gaining popularity. However, postoperative hypocalcemia, including Hungry Bone Syndrome (HBS), remains a major concern. Aim: This study seeks to evaluate the surgical outcomes of FP in patients with PHPT, analyze the usefulness of intraoperative parathyroid hormone (IOPTH) assessment, and evaluate the efficacy of postoperative management with calcium and vitamin D supplements. Materials and methods: One hundred forty-two patients with sporadic PHPT who underwent parathyroidectomy at Fortis Hospital Shalimar Bagh, Delhi, between March 2018 and December 2023 were participants in a retrospective analysis. The abnormal parathyroid glands were identified by high-resolution neck ultrasonography and SestaMIBI scans used in preoperative imaging. After 15 minutes of gland removal, IOPTH was measured and compared with the preoperative PTH levels. Supplementing with calcium carbonate and calcitriol was part of the postoperative care. For a minimum of 6 months, patients were monitored to track serum calcium levels and recurrence rates. Results: One hundred eighteen of the 142 patients (83.1%) who had concordant imaging underwent successful FP. The average serum calcium level was 11.5 ± 1.2 mg/dL, and the average preoperative parathyroid hormone (PTH) level was 230.2 ± 96 pg/mL. In 17.6% of cases, patients experienced transient hypocalcemia, and 4.9% experienced HBS. There were two recurrent cases, but the overall cure rate was 98.6%. Conclusion: FP is a highly effective surgical treatment for PHPT, with a success rate similar to standard bilateral exploration. Routine IOPTH assessment is indicated to improve patient outcomes. Empirical calcium and vitamin D treatment after surgery reduced the prevalence of hypocalcemia and HBS. This study emphasizes the possibility for more widespread use of FP and IOPTH in developing nations.

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