Long-Term Symptom Relief from Primary Hyperparathyroidism Following Minimally Invasive Parathyroidectomy

The affect of the surgical approach for primary hyperparathyroidism (1HPT) on long-term symptom relief has not been studied. This study compares the long-term relief of symptoms assessed by the Parathyroidectomy Assessment of Symptoms (PAS) score in patients undergoing bilateral neck exploration (BNE) and minimally invasive parathyroidectomy (MIP). In this case-control study, patients with 1HPT who had followed a protocol to assess symptoms before and after parathyroid surgery between 1999 and 2008 were contacted by letter and had blood taken to assess calcium, ionized calcium, and parathyroid hormone (PTH). The main aim was to assess symptoms at long-term follow-up using the PAS score. The incidence of persistent or recurrent 1HPT at long-term follow-up after MIP and BNE was also compared. Two hundred and forty-six patients underwent parathyroid surgery and 142 responded to our correspondence, of which 64 underwent MIP and 78 BNE. Follow-up after BNE was longer than MIP (61 vs. 41 months). At long-term follow-up, the mean PAS score fell by 125 and 175 in the MIP and BNE groups, respectively. There was no statistically significant difference in the decline of the PAS score between the MIP and BNE groups. Six patients developed persistent or recurrent 1HPT following MIP compared to three after BNE; this difference was not statistically significant. This study is the first to report on long-term symptom relief from 1HPT after MIP, and demonstrates that both MIP and BNE can achieve this. In order to establish whether the long-term outcomes from these procedures are equivalent, further adequately powered studies are required.