Primary Hyperparathyroidism Recurrence Is Low Following Parathyroidectomy

Long-term surgical outcomes following parathyroidectomy show a limited primary hyperparathyroidism recurrence, according to a study published in The Journal of Clinical Endocrinology and Metabolism.

Researchers included 34 studies in a meta-analysis to examine primary hyperparathyroidism recurrence among individuals who underwent parathyroidectomy. The team examined 5- and 10-year recurrence rates, defined as the re-emergence of hypercalcemia at least 6 months after successful parathyroidectomy, and assessed the effect of diagnosis and surgical procedure on surgical outcomes.  

Among a cohort of  30,658 participants (median sample size, n=277), 10,353 patients had single adenoma/glandular disease and 1904 had multiglandular disease (double ademona, n=524; hyperplasia, n=594). Surgical interventions included bilateral exploration (n=21,197), unilateral exploration (n=5253), and minimally invasive parathyroidectomy (n=2345).  

A pooled analysis estimated overall primary hyperparathyroidism recurrence rates to be 1.56% (95% CI, 0.96%-2.28%), with 5- and 10-year recurrence rates of 0.23% (95% CI, 0.04%-0.53%) and 1.03% (95% CI, 0.45%-1.80%), respectively. Single and multiglandular recurrence rates were similar (2.60% vs 0.00%; P =.343), and patients undergoing unilateral, bilateral, and minimally invasive procedures experienced similar recurrence rates (1.07% vs 0.70% vs 1.46%; P =.945).

A secondary combined analysis consisting of individuals undergoing unilateral and minimally invasive procedures produced an estimated primary hyperparathyroidism recurrence rate of 1.22% (95% CI, 0.24%-2.76%), which was not significantly different from the recurrence rate of individuals undergoing the bilateral procedure (P =.911).

Limitations include a lack of uniformity in reporting loss to follow up, a high contribution of heterogeneity to the variation in the pooled overall and 10-year recurrence rates, and variations in the way observational studies reported outcomes of interest.  

“Based on the currently available evidence, one parathyroidectomy modality is not superior to another regarding long-term recurrence rates,” according to the study authors.