Hyperparathyroidism: Therapy and Response, with a Test for Assessment of Response

Postoperative observation for 44 patients with primary hyperparathyroidism (parathyroidal), reported in 1966, further supports the contention that partial parathyroidectomy is effective treatment. Twenty-five more patients have been treated since that report. Most were brought to surgery by screening for hypercalcemia. A rising incidence of multigland disease was noted, together with an increased frequency of treatment failure, which suggests primary hyperparathyroidism is now diagnosed earlier in the evolution of parathyroid dysfunction than before. Because of occasional nonspecific falls in serum calcium after noncurative partial parathyroidectomy, demonstrated in this study, another index for evaluation of cure was investigated. The hypophosphaturic response to curative surgery noted in 1966 was evaluated further and found to be an excellent index of cure; its absence heralded treatment failure. Five subjects with inconclusive explorations were reviewed: they benefited from the surgery, but no pathological abnormalities were identified. Criteria for diagnosis of early disease need clarification.