The role of surgery in managing recurrent hyperparathyroidism
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20243413Keywords:
RHPT, Parathyroidectomy, MGD, Surgical management, ReoperationAbstract
Recurrent hyperparathyroidism (RHPT) presents a complex surgical challenge after initial treatment for primary hyperparathyroidism (PHPT). Characterized by hypercalcemia following a previously successful parathyroidectomy, RHPT requires accurate diagnosis and careful management to avoid complications. Preoperative imaging advancements and intraoperative parathyroid hormone (PTH) monitoring have reduced recurrence rates from 30% to 2.5%-5%, though they can be as high as 14% in some cases. Persistent hyperparathormonemia, multigland disease (MGD), and conditions such as parathyroid carcinoma contribute to recurrence. Factors such as age, imaging results, and PTH levels influence recurrence risk, with studies identifying older age and double adenomas as predictors. Surgical reintervention carries significant risks, including recurrent laryngeal nerve (RLN) palsy and permanent hypocalcemia. Monitoring biochemical markers over time, including calcium and PTH levels, remains essential. This review explores the causes of RHPT, surgical management strategies, and factors predicting recurrence, with a focus on individualized patient care and minimizing surgical risks. Successful management requires a balance between reoperation necessity and potential complications.
Metrics
References
Fraser WD. Hyperparathyroidism. Lancet (London, England). 2009;374(9684):145-58.
Michels TC, Kelly KM. Parathyroid disorders. American family physician. 2013;88(4):249-57.
Olguín Joseau S, Arias A, Garzón A, Peretti E, Guzmán L, Ruggieri M. Risk factors for surgical failure in patients undergoing surgery for primary hyperparathyroidism. Cirugia espanola. 2022;100(9):569-72.
Aygün N, Uludağ M. Surgical Treatment of Primary Hyperparathyroidism: Which Therapy to Whom? Sisli Etfal Hastanesi tip bulteni. 2019;53(3):201-4.
Pavlidis ET, Pavlidis TE. Update on the current management of persistent and recurrent primary hyperparathyroidism after parathyroidectomy. World J Clin Cases. 2023;11(10):2213-5.
Udelsman R. Approach to the patient with persistent or recurrent primary hyperparathyroidism. J Clin Endocrinol Metabol. 2011;96(10):2950-8.
Nawrot I, Chudziński W, Ciąćka T, Barczyński M, Szmidt J. Reoperations for persistent or recurrent primary hyperparathyroidism: results of a retrospective cohort study at a tertiary referral center. Med Sci Monitor. 2014;20:1604.
Guerin C, Paladino NC, Lowery A, Castinetti F, Taieb D, Sebag F. Persistent and recurrent hyperparathyroidism. Updates Surg. 2017;69(2):161-9.
Szabo Yamashita T, Mirande M, Huang CT, Ann K, Ria F-F, Ravinder S, et al. Persistence and Recurrence of Hypercalcemia After Parathyroidectomy Over 5 Decades (1965-2010) in a Community-based Cohort. Ann Surg. 2023;278(2):e309-13.
Lai V, Yen TW, Doffek K, Azadeh AC, Ty BC, Gilbert GF, et al. Delayed Calcium Normalization After Presumed Curative Parathyroidectomy is Not Associated with the Development of Persistent or Recurrent Primary Hyperparathyroidism. Ann Surg Oncol. 2016;23(7):2310-4.
Wang TS, Ostrower ST, Heller KS. Persistently elevated parathyroid hormone levels after parathyroid surgery. Surgery. 2005;138(6):1130-6.
Denizot A, Pucini M, Chagnaud C, Botti G, Henry J-F. Normocalcemia with elevated parathyroid hormone levels after surgical treatment of primary hyperparathyroidism. The American journal of surgery. 2001;182(1):15-9.
Marx SJ, Stock JL, Attie MF, Downs Jr RW, Gardner DG, Brown EM, et al. Familial hypocalciuric hypercalcemia: recognition among patients referred after unsuccessful parathyroid exploration. Ann Internal Med. 1980;92(3):351-6.
Uludag M, Unlu MT, Kostek M, Caliskan O, Aygun N, Isgor A. Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Pre-Operative Evaluation. Sisli Etf al Hastanesi tip bulteni. 2023;57(1):1-17.
Shirali AS, Wu S-Y, Chiang Y-J. Recurrence after successful parathyroidectomy-Who should we worry about? Surgery. 2022;171(1):40-6.
Mallick R, Nicholson KJ, Yip L, Carty SE, McCoy KL. Factors associated with late recurrence after parathyroidectomy for primary hyperparathyroidism. Surgery. 2020;167(1):160-5.
Lou I, Balentine C, Clarkson S, Schneider DF, Sippel RS, Chen H. How long should we follow patients after apparently curative parathyroidectomy? Surgery. 2017;161(1):54-61.
Schneider DF, Mazeh H, Chen H, Sippel RS. Predictors of recurrence in primary hyperparathyroidism: an analysis of 1386 cases. Ann Surg. 2014;259(3):563-8.
Ryder CY, Jarocki A, McNeely MM. Early biochemical response to parathyroidectomy for primary hyperparathyroidism and its predictive value for recurrent hypercalcemia and recurrent primary hyperparathyroidism. Surgery. 2021;169(1):120-5.
Lim JY, Herman MC, Bubis L. Differences in single gland and multigland disease are seen in low biochemical profile primary hyperparathyroidism. Surgery. 2017;161(1):70-7.
Henry J-F. Reoperation for primary hyperparathyroidism: tips and tricks. Langenbeck's Arch Surg. 2010;395:103-9.
Grant CS, Thompson G, Farley D, van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg. 2005;140(5):472-8.
Richards ML, Thompson GB, Farley DR, Grant CS. Reoperative parathyroidectomy in 228 patients during the era of minimal-access surgery and intraoperative parathyroid hormone monitoring. Am J Surg. 2008;196(6):937-42.
Yen TW, Wang TS, Doffek KM, Krzywda EA, Wilson SD. Reoperative parathyroidectomy: an algorithm for imaging and monitoring of intraoperative parathyroid hormone levels that results in a successful focused approach. Surgery. 2008;144(4):611-9.
Jain M, Krasne DL, Singer FR, Giuliano AE. Recurrent primary hyperparathyroidism due to Type 1 parathyromatosis. Endocrine. 2017;55(2):643-50.
Young S, Wu JX, Li N, Yeh MW, Livhits MJ. More extensive surgery may not improve survival over parathyroidectomy alone in parathyroid carcinoma. Ann Surgical Oncol. 2016;23:2898-904.
Wheeler MH, Williams ED, Wade JS. The hyperfunctioning intrathyroidal parathyroid gland: a potential pitfall in parathyroid surgery. World J Surg. 1987;11(1):110-4.
