Success of cervical exploration for patients with asymptomatic primary hyperparathyroidism

Background: This study examined the success and safety of cervical exploration in patients with asymptomatic primary hyperparathyroidism compared with those with symptomatic disease. Methods: Records of patients undergoing cervical exploration for primary hyperparathyroidism from June 1990 to October 1996 were reviewed. Patients were divided into three groups: (1) asymptomatic, (2) symptomatic, and (3) afflicted (those with associated complications). Information collected consisted of preoperative and postoperative symptoms, serum calcium and parathyroid hormone levels (PTH), and descriptions of pathologic and operative findings. Results: Sixty-one patients were identified. Nineteen (31%) had no symptoms, 21 (34%) had subjective symptoms, and 21 had associated conditions, as described. Average preoperative and postoperative calcium levels were 11.5 mg% and 8.5 mg%, respectively. Average PTH levels also fell from 142 pg/mL to 49 pg/mL after surgery. Preoperative and postoperative calcium and PTH levels for the three groups showed no significant differences. The success of surgery in identifying pathology ranged from 90.5% to 95%, and again showed no difference among the three groups. Long-term morbidity (>6 months) in all groups was 0%. Conclusions: Cervical exploration and parathyroidectomy for asymptomatic primary hyperparathryoidism is safe and has similar success rates in identifying pathology and correcting biochemical abnormalities compared with patients with symptomatic disease.