Postoperative Management of Primary Hyperparathyroidism

Postoperative management of patients with primary hyperparathyroidism requires to determine whether the operation has succeeded or not in early postoperative days as well as to deal with postoperative hypoparathyroidism. Twenty three surgically managed patients with primary hyperparathyroidism were studied. Attention was focused on the time course of postoperative serum calcium levels and postoperative hypocalcemic signs. The following conclusion were obtained. When the surgery was successful, the serum total calcium levels fell·to normal range within 48 hours, then below normal range and gradually returned to normal. It took about one to three months for the serum calcium levels to return to normal. Severe postoperative hypocalcemic signs were observed in those patients with extensive bone disease and high serum alkaline phosphatase activities, in those where initial hypocalcemic signs appeared within 24 hours after surgery, and in those where plasma total calcium levels continued to decrease after the fourth postoperative day. Calcium should be administered only to patients with severe hypocalcemic signs or to those with postoperative congestive heart failure. The second exploration should be performed without delay when the fluctuating hypercalcemia persists after the operation.