Abstract
Parathyroidectomy needs skill and experience for its tiny size and variation in number and location. The retrospective quasi-experimental study of 26 parathyroid operations was done in endocrine surgery unit of BSMMU during October 1994 to March 2007. All patients were within 31 to 50 years of age with female preponderance (M:F=1:5.5). All the patients had primary hyperparathyroidism diagnosed biochemically with variable rise of serum calcium and serum intact parathormone level and finally proved as single parathyroid adenoma after surgery. Different preoperative localization tests were done in 22 patients with positive impression in all except 2 (7.69%) sestamibi scan. The sestamibi scan showed 50% (2/4) negative impression which, later on, was proved as 100% false negative at surgery. Bilateral neck exploration (BNE) was done on 18 patients with 94.44% success of surgery and ‘focused' parathyroidectomy by unilateral neck exploration (UNE) was done on 7 patients of whom 4 underwent local anaesthesia with 100% success of gland removal. Temporary postoperative hypocalcaemia was observed in 22 patients. Full recovery from hypocalcaemia was in 20 (90.90%) patients though 2 (7.69%) patients with late diagnosis showed irreversible outcome not due to surgery but due to postoperative complex renal and cardiovascular deterioration. Focused parathyroidectomy can be safely done even under local anaesthesia in tertiary hospital. Key words: Primary hyperparathyroidism; preoperative localization; focused parathyroidectomy; local anaesthesia.DOI: 10.3329/bsmmuj.v2i1.3708 BSMMU J 2009; 2(1): 31-35
Highlights
Primary hyperparathyroidism is usually a late diagnosis as a cause of hypercalcaemia
Unilateral focused parathyroidectomy was done on 8 patients and other 18 underwent bilateral neck exploration
Sestamibi scan was negative in 50%( 2/4) cases
Summary
Primary hyperparathyroidism is usually a late diagnosis as a cause of hypercalcaemia. Most often endocrine surgeon is demanded for surgical management of hyperactive parathyroid gland(s) after diagnosis by specialist urologist, orthopaedic surgeon, endocrinologist or even psychiatrist. After biochemical diagnosis by raised serum calcium and serum parathormone (PTH), preoperative localization tests are done to identify the number and location of hyperactive glands for appropriate approach to gland removal. Parathyroid surgery is one of the highly technical procedures due to its tiny size, variation of location and infrequent and limited exposure and experience of the surgeon. Due to reduced sensitivity and specificity of localization tests, localization of a ‘skilled parathyroid surgeon’ was preferred to tests and parathyroidectomy by bilateral neck exploration (BNE) was the standard modality of treatment.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
