Abstract

Objective: Primary hyperthyroidism is the 3rd most com­ mon endocrine disease and the most common cause of hypercalcemia in outpatients. The most common cause of primary hyperthyroidism and hypercalcemia is parathyroid adenoma. Surgery is the treatment of choice for all sympto­ matic and in some cases of asymptomatic primary hyper­ parathyroidism. In this study we intend to present clinical outcomes of patients managed surgically for primary hyperpathyroidism.

Material and methods: We retrospectively studied files of 202 patients who underwent surgery for primary hyperthyroidism between January 1999 and February 2019. The patients clinical and demographic characteristics were analyzed. The patients were then classified based on clinical and biochemical presentation for primary hyperthyroidism.

Results: There were 165 (81.7%) female and 37 (18.3%) male patients, with overall mean age of 52 (17­82). The most common presenting symptom was musculoskeletal pain. According to their clinical presentation 141 (69.8%) patients were symptomatic whereas 54 (26.7%) were asymptomatic, 5 (2.5%) were normocalcemic and 2 (1%) patients were mildy hypercalcemic. According to bioche­ mical presentation 194 (96%) patients were classic, 5 (2.5%) patients were normocalcemic and 3 (1.4%) patients were classified as non­classic group. Preoperative ultraso­nography was performed in 186, scintigraphy in 192 and preoperative magnetic resonance study performed in 12 pa­ tients. Forty­three (21.3%) patients received medical tre­ atment for hypercalcemia prior to surgery. Minimal invasive surgery was carried out on 139 (68.8%) patients. Forty­three (21.3%) patients underwent simultaneous thyroidectomy. Hematoma was seen in 4 (2%) patients who underwent simultaneous thryoidectomy. Recurrence was reported in 19 (9.4%) patients (7 discontinued treatment at our centre, 3 successfully underwent reoperation while 9 were maintained on medical management) where as per­ sistent pHPT was reported in 10 (4.9%) patients (8 were maintained on medical treatment and follow­up, 2 were discontinued follow­up at our centre). Based on patholoical study reports 189 (93.5%) patients had adenoma, 7 (3.5%) had hyperplasia while 6 (3%) had carcinoma.

Discussion: Primary hyperthyroidism poses serious medi­ cal and social risks if not treated. In high­volume centres with necessary multidisciplinary team and facilities that allow proper preoprative localization primary hyperthyroi­ dism is treated with resultant low morbidity.