Late parathyroid function after successful parathyroidectomy guided by intraoperative hormone assay (QPTH) compared with the standard bilateral neck exploration

BACKGROUND: Controversy continues between bilateral neck exploration and limited parathyroidectomy. One approach depends on gland size and histopathologic factors; the other approach limits excision to only hypersecreting glands. Both have excellent early operative success, but late recurrence rates with limited exploration are unknown. METHODS: Three hundred twenty consecutive patients with primary hyperparathyroidism were followed 6 to 313 months after successful parathyroidectomy. One hundred seventy-six patients had bilateral neck exploration with excision of enlarged glands (group I); 144 patients had glands excised based on hyper-secretion (group II). Calcium and intact parathyroid hormone (iPTH) levels were measured yearly. Parathyroid gland hypersecretion was determined by elevated iPTH levels. RESULTS: In group I, 1 gland was excised in 160 patients (91%); 19 of 176 patients (11%) had elevated iPTH levels. In group II, 139 patients (97%) had 1 gland excised; 19 of 144 patients (13%) had high iPTH levels. The number of patients with more than 1 gland excised in group I (9%) is 3 times higher than in group II (3%) (P <.05). There was no significant difference in the incidence of recurrent hyperfunctioning glands between the 2 different operative approaches (chi-squared test). CONCLUSIONS: Late parathyroid gland function was comparable with both approaches. Multiple gland excision based on size alone may lead to excision of normal functioning glands.