Asymptomatic vs Symptomatic Primary Hyperparathyroidism: Comparison of Clinico-investigative Profile and Surgical Outcomes in Resource-Limited Setting

Abstract

This study was done to assess compare usefulness of localization (MIBI and USG) and surgical cure rates in APHPT with SPHT surgical. Multi-centric retrospective study. 57 APHPT and 156 SPHPT patients included. The demographic data &localisation studies between APHPT and SPHPT along with surgical cure rates in patients who had localized disease versus nonlocalized were compared. APHPT prevalence was 26.76%. APHPT affects older patients (p=<0.05). Serum calcium & PTH were higher in SPHPT (p=<0.05). USG & MIBI scans were positive in 88% and 90% in SPHPT. APHPT showed USG and MIBI positivity in 21.05% and 15.7%. Subset of APHPT patients (n=13) who underwent additional imaging showed true positive lesion in 38.5% (n=5). Bilateral neck exploration done in 73.7% of APHPT& 10.9% of SPHPT (p=0.0001). APHPT has smaller adenoma(p<0.05). In non-localized APHPT (n=42) five needed partial thyroidectomy (11.9%) and six partial thymectomy (14.2%). Intra operative success rate was 97.5% in SPHPT and 95.23% in non-localized APHPT (p=0.63). APHPT presents with mild disease and mostly with negative localization. Cure rates after bilateral neck exploration without additional imaging like PETCT/4D CT/MRI was similar to SPHPT