Initial parathyroid exploration: Current trends in Australia

Background: An Australia-wide multicentre prospective study was undertaken to audit cases of initial parathyroid exploration between January and 31 December 1992. One hundred and sixty-two cases were audited. The audit was designed to study pre-operative biochemical assessment, localization techniques and the technique of exploration. Method: A pro forma audit form was circulated to all Australian surgeons known to perform parathyroid surgery. Eleven responded. Results: Free serum ionized calcium (iCa) was measured in 30% of cases, with the majority of pre-operative calcium assays being performed using total serum calcium (tCa). In 40 cases (29%) pre-operative localization techniques were used. These proved inaccurate in 10 cases. The intra-operative technique of localization with methylene blue infusion was used in 11% of cases. All four glands were biopsied in 11% of cases. No deaths were reported and a postoperative morbidity rate of 3.1% was noted. Eighty-eight per cent of patients were discharged within 5 days of surgery with a third going horne within 48 h of neck exploration surgery. Only one patient (0.6%) required re-exploration for persistent hypercalcaemia due to a second adenoma. Conclusions: The surgical treatment of hyperparathyroidism can be regarded as safe, with minimum morbidity in experienced hands. Pre-operative localization studies in initial parathyroid exploration are not indicated.