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Biomedical subjects

O H Clark

Publications and source records attributed to O H Clark.

At least 127 records · Page 7Linked to original sources
PubMed1994

Primary parathyroid hyperplasia associated with thyroid hemiagenesis and agenesis of the isthmus.

BACKGROUND: Congenital thyroid anomalies can be caused by abnormal descent or agenesis of part of the thyroid gland. Agenesis of the thyroid gland may involve one or both lobes of the gland, with or without isthmus, and is very rare. Congenital thyroid anomalies have been reported to be associated with thyroid diseases (hyperthyroidism, adenomatous goiter, and cancer) but not with parathyroid diseases. METHODS: Case reports of two patients describe the methods used. RESULTS: We report two patients with hyperparathyroidism and congenital thyroid anomalies. One patient had a left thyroid lobe hemiagenesis and the other patient had agenesis of the thyroid isthmus. Both patients had primary hyperparathyroidism caused by parathyroid hyperplasia and were treated by subtotal parathyroidectomy. The parathyroid glands and recurrent laryngeal nerves were in their usual positions despite the abnormal development of the thyroid glands. CONCLUSIONS: When thyroid hemiagenesis or isthmus agenesis is found in patients undergoing parathyroidectomy for hyperparathyroidism, parathyroid hyperplasia should be suspected. If parathyroid hyperplasia is present, subtotal parathyroidectomy and bilateral thymectomy are recommended. The parathyroid glands and the recurrent laryngeal nerves can be found in their usual locations.

Adult↗
PubMed1993

Diagnosis, treatment, and outcome of follicular thyroid carcinoma.

BACKGROUND: There have been numerous studies concerning the diagnosis, treatment, and prognosis of patients with papillary thyroid carcinoma, but relatively few addressing patients with follicular carcinoma. METHODS: The authors analyzed their experience with 65 patients who underwent 96 thyroid operations for pure follicular thyroid carcinoma from 1956 to 1990. RESULTS: The patients were 43 women and 22 men with a mean age of 45 years who were followed postoperatively for a mean of 10.4 years. Fifty-two patients (80%) were seen initially with a solitary thyroid nodule, and 24 (37%) had symptoms at presentation. Median tumor size was 2.2 cm. Fine-needle aspiration biopsy was performed in 20 patients, revealing a follicular neoplasm in 18 patients (90%) and an inadequate specimen in 2 patients. Nineteen patients received thyroid-stimulating hormone (TSH)-suppressive thyroid hormone therapy for an average of 4.5 months before surgery; tumor size remained the same in 10 patients (53%), increased in 5 (26%), and decreased in 2 (11%). At presentation, six patients had lymph node involvement, three had locally invasive tumors, and two had distant metastases. Initial operative treatment was lobectomy in 32 patients (49%), total thyroidectomy in 15 patients (23%), lobectomy plus contralateral partial or subtotal lobectomy in 11 patients (17%), and lesser procedures in 7 patients (11%). Twenty-nine patients had a completion total thyroidectomy, so that final surgical treatment consisted of total thyroidectomy in 44 patients (68%). Among 39 patients having intraoperative frozen section, only 3 (8%) were correctly diagnosed as having cancer. Permanent complications occurred during 3 of the 96 operations. Three patients (5%) have died of thyroid cancer (one with anaplastic transformation) since thyroidectomy, and two are living with distant metastatic disease. CONCLUSIONS: Patients with follicular thyroid cancer, when first examined, usually have solitary thyroid nodules that are follicular neoplasms by aspiration cytology, and these nodules fail to regress in response to TSH-suppressive therapy. Frozen section rarely aids in management. The preferred treatment for follicular neoplasms is lobectomy followed by completion total thyroidectomy for histologically proven carcinomas larger than 1.0 cm. Total thyroidectomy allows use of thyroglobulin and radioiodine scanning to detect and treat metastatic disease. Complications of thyroidectomy were uncommon, and the mortality rate in treated patients was relatively low.

Adenocarcinoma, Follicular↗
PubMed1993

Thyrotropin stimulates invasion and growth of follicular thyroid cancer cells via PKC- rather than PKA-activation.

The signal transduction of TSH in invasion and growth of FTC 133, a human follicular thyroid cancer cell line, was investigated. TSH (0.01-1 mIU/ml) stimulated invasion of FTC 133 by 21% and growth by 20% of basal. Cyclic AMP-stimulators and inhibitors had no effect at any concentration. The PKC-agonist TPA enhanced invasion and growth by 15%, whereas staurosporine, a PKC-antagonist, inhibited them by 32% and 60%, respectively. The latter also reversed TSH stimulation. EGF enhanced invasion (42%) and growth of FTC 133 (25%). Staurosporine did not reverse EGF stimulation. The tyrosine kinase antagonist genistein reversed EGF, but not TSH stimulation. Pertussis toxin inhibited invasion (18%) and growth (22%). Cholera toxin was less inhibitive. We demonstrated for the first time, that TSH stimulates invasion and growth of human thyroid cancer cells in vitro by PKC- rather than PKA-stimulation.

Alkaloids↗
PubMed1993

Tumoral calcinosis. Controversies in the etiology and alternatives in the treatment.

OBJECTIVE: To examine our experience and review the literature concerning the diagnosis, origin, and treatment of tumoral calcinosis (TC). DESIGN/SETTING: Case series based on patients with TC treated in University of California-San Francisco hospitals from 1981 to 1992 and the review of the patients described in the English-language literature. PATIENTS: The study included a total of 17 patients: 10 women and seven men. MAIN OUTCOME MEASURES: Sex, age, origin, symptoms, localization, treatment, and morbidity. RESULTS: Seven men and six women, from 32 to 62 years of age, had known disorders of calcium metabolism, and four women, from 37 to 84 years of age, did not. The main causes of the calcium metabolic disorder were secondary hyperparathyroidism in 11 patients (85%) and primary hyperparathyroidism in two patients. In three patients there was a history of trauma at the involved site and in one patient the origin was unknown. Swelling and pain are the most common presenting complaints. Generalized pruritus was observed in 54% of the patients with metabolic disorders (P < .001) but not in patients without metabolic disorders. Among our patients with metabolic disorders, TC occurred most frequently at the shoulder (46%) and elbow (31%). Eleven patients with secondary hyperparathyroidism had received calcium carbonate to bind phosphate, a high level of calcium in the dialysate, and calcitriol (1,25-vitamin D) either orally, intravenously, or both, and three received epoetin alfa (Epogen). Following parathyroidectomy, the patients with hyperparathyroidism improved symptomatically, although calcifications did not change in size. One patient had the calcifications resected and did well, whereas another was treated by subtotal resection and had a recurrence 3 years later. All four of our patients without a metabolic disorder had complete resection of TC with no recurrence. CONCLUSION: We believe TC is becoming more common in uremic patients with secondary hyperparathyroidism because of recent changes in the medical treatment of these patients. The increased use of calcium carbonate to bind phosphate as well as calcitriol and calcium to suppress parathyroid function and possibly epoetin alfa are causing more patients to develop TC.

Adult↗
PubMed1993

Effects of hyperparathyroidism on blood lead concentrations in man.

To investigate whether hyperparathyroidism has an effect on blood lead (Pb) concentrations and whether parathyroidectomy will alter blood Pb concentrations, we studied 15 subjects with primary hyperparathyroidism (HPTH) and 7 control subjects with thyroid nodules (TC). Blood Pb concentrations were determined several weeks prior to surgery and then again 4 months later. A reference group (REF) of nonsurgical lab/office workers was examined over the same periods of time. Initial mean blood Pb concentrations were 6.6 +/- 2.8, 6.0 +/- 2.9, and 5.0 +/- 1.7 micrograms/dl for the HPTH, TC, and REF groups (not significantly different), respectively. The mean percentage changes in blood Pb (before vs after) were -13.9, -4.9, and -6.1%. While the paired changes in blood Pb concentrations within the HPTH group were significant (P < 0.05), the percentage changes compared to either of the TC or REF groups were not significantly different. The percentage change in blood Pb correlated with the percentage change in serum calcium across all subjects (r = 0.5176, P = 0.0024, n = 24), although this correlation was not significant within any group alone. The HPTH group demonstrated expected changes in serum calcium, parathyroid hormone, and alkaline phosphatase concentrations. Three of the HPTH subjects received a CaNa2 EDTA chelation challenge (1 g intramuscularly) before and 4 months after surgery. Chelated amounts of Pb (microgram/24 hr before vs after) were 52 vs 38, 42 vs 47, and 60 vs 34. These data indicate that in the high bone turnover state of hyperparathyroidism that Pb concentrations in the blood-soft tissue compartment, and probably Pb mass, are not likely to be different from other individuals. Also parathyroidectomy results in a lowering of blood Pb concentrations possibly due to parallel movements of calcium.

Adult↗
PubMed1993

Increased phospholipase C activity in neoplastic thyroid membrane.

The phospholipase C (PLC)-protein kinase C (PKC) signal transduction pathway appears to be important for cellular growth of many normal and neoplastic tissues. Because alterations in the thyroid-stimulating hormone (TSH) receptor-adenylate cyclase-protein kinase A system in some thyroid tumors do not correlate with tumor size, invasiveness, or metastatic potential, we studied the PLC activity in both normal and neoplastic thyroid tissues from 11 patients. Five of these patients had follicular adenomas and 6 had papillary carcinomas. An 8,000 x g membrane fraction and a 105,000 x g cytosol fraction were prepared from the normal and neoplastic human thyroid tissues. PLC hydrolyzes phosphatidylinositol, 4,5-diphosphate (PIP2) to diacylglycerol (DAG) and inositol 1,4,5-triphosphate (IP3). Phospholipase C activity was determined measuring the hydrolysis of [3H]-PIP2. The activity of PLC in the neoplastic thyroid tissue membrane fraction (20.91 +/- 2.28 nmol PIP2 hydrolyzed/mg protein/120 min) was higher than that in normal thyroid membrane (14.27 +/- 0.82) (p < 0.05). In contrast, PLC activity was similar in the neoplastic (16.12 +/- 0.86 nmol PIP2 hydrolyzed/mg protein/120 min) and normal (16.66 +/- 0.60) cytosol. There was no difference between PLC activity in the membrane fraction from adenomas (21.21 +/- 3.71 nmol PIP2 hydrolyzed/mg protein/120 min) when compared with thyroid carcinomas (20.67 +/- 3.14). Neoplastic thyroid membranes have greater PLC activity than that found in normal thyroid membranes from the same patients. Although PLC activity in benign and malignant thyroid membranes was similar, the increased PLC activity in thyroid neoplasms may be responsible for or contribute to the enhanced growth of some thyroid tumors.

Adenoma↗
PubMed1993

Double parathyroid adenomas. Clinical and biochemical characteristics before and after parathyroidectomy.

OBJECTIVE: There is considerable debate about whether double parathyroid adenomas are a discrete entity or represent hyperplasia with parathyroid glands of varying sizes. This distinction is important because it impacts on the extent of parathyroid resection and the success of the parathyroid operation. SUMMARY BACKGROUND DATA: Double parathyroid adenomas have been reported to occur in 1.7% to 9% of patients with primary hyperparathyroidism (HPT). It is important for surgeons to differentiate between double adenoma and hyperplasia with glands of varying sizes using gross examination during the initial procedure because microscopic findings of a small biopsy specimen at frozen-section examination may not be diagnostic. METHODS: From 1982 to 1992, 416 unselected patients (309 women and 107 men) with primary HPT without familial HPT or multiple endocrine neoplasia (MEN) were treated by one surgeon at the University of California at San Francisco. Double adenoma occurred in 49 patients, solitary adenoma in 309 patients, and hyperplasia in 58 patients. The authors analyzed the clinical manifestations, the preoperative and postoperative serum levels of calcium, phosphate, and parathyroid hormone (PTH), and the success rate and outcome after parathyroidectomy and compared their results in 49 patients with double adenomas to the results for patients with solitary adenomas or hyperplasia. RESULTS: Ten of the patients with double adenomas (20.4%) were referred for persistent HPT after removal of one abnormal parathyroid gland. The ages of the patients with double adenoma, single adenoma, and hyperplasia were 61 +/- 14, 56 +/- 15, and 58 +/- 7 years, respectively. Fatigue, muscle weakness, and bone pain were common in patients with double adenomas, whereas nephrolithiasis occurred more frequently in patients with solitary adenoma (p = 0.0001). Serum calcium and PTH levels (per cent of upper limit of normal) fell from 11.5 +/- 1.2 mg/dL and 487% to 9.5 +/- 0.8 mg/dL and 61% for patients with double adenomas; from 11.9 +/- 0.9 mg/dL and 378% to 9.3 +/- 1.4 mg/dL and 101% for patients with single adenoma; and from 10.9 +/- 0.5 mg/dL and 418% to 9.1 +/- 0.7 mg/dL and 94% for patients with hyperplasia, respectively. There was no recurrence in the patients with double adenomas with a mean follow-up time of 5.8 years. CONCLUSIONS: Double adenomas are a discrete entity and occur more often in older patients. Patients with double adenomas can be successfully treated by removal of the two abnormal glands.

Adenoma↗
PubMed1993

Localization of abnormal parathyroid glands of the mediastinum with MR imaging.

PURPOSE: To determine the sensitivity of magnetic resonance (MR) imaging for preoperative localization of abnormal parathyroid glands in the mediastinum and to compare the sensitivity of MR imaging with those of scintigraphy and ultrasonography (US). MATERIALS AND METHODS: The prospective sensitivity of MR imaging was compared with those of thallium-technetium scintigraphy and US in 25 patients in whom the abnormal gland was located in the mediastinum at surgery. RESULTS: MR imaging had a much higher sensitivity (22 of 25 cases [88%]) than did scintigraphy (11 of 19 cases [58%]) or US (three of 24 cases [12%]). The most common locations for the mediastinal gland were intrathymic (eight of 25 cases) and paraesophageal (six of 25 cases) sites. CONCLUSION: MR imaging should be considered the modality of choice for preoperative localization in this group of patients.

Adenoma↗
PubMed1993

Production of parathyroid hormone by a malignant nonparathyroid tumor in a hypercalcemic patient.

Few cases exist in which the production and secretion of PTH by malignant nonparathyroid tumors have been authenticated. A 69-yr-old man developed hypercalcemia complicating a primitive neuroectodermal malignancy that was widely metastatic. The serum level of intact PTH was markedly increased by immunoradiometric assay (90-290 ng/L; normal, 10-65 ng/L). The serum level of a PTH-related protein was also increased (19-20 ngeq/L; normal, < 10 ngeq/L). Exploration of the neck and mediastinum at two operations revealed four normal parathyroid glands. Extracts of the metastatic tumor contained immunoreactive PTH and transcripts of both the PTH and PTH-related protein genes. Thus, hypercalcemia in this patient was associated with production of PTH by a nonparathyroid malignancy.

Aged↗
PubMed1993

Detection of abnormal parathyroid glands in postoperative patients with recurrent hyperparathyroidism: sensitivity of MR imaging.

OBJECTIVE: The efficacy of MR imaging in identifying abnormal parathyroid glands in patients with recurrent hyperparathyroidism after surgery was investigated. SUBJECTS AND METHODS: Findings on preoperative T1- and T2-weighted MR images in 44 patients with recurrent hyperparathyroidism were prospectively evaluated and compared with surgical/pathologic results in all patients. A blinded retrospective analysis of the MR findings comparing T1- or T2-weighted images alone and in combination for detection of abnormal parathyroid glands also was performed. RESULTS: Seventy-four percent of surgically proved abnormal parathyroid glands were detected prospectively and 65% were detected retrospectively on MR images. The combination of T1- and T2-weighted images increased the sensitivity for detection. The sensitivity for detection of abnormal glands was 72% in the neck and 86% in the mediastinum. The sensitivities for detecting parathyroid adenomas (80%) and hyperplastic glands (69%) were not significantly different. There was no threshold volume for detection of lesions with MR imaging. Both intrathyroid parathyroid adenomas were missed on MR images. Abnormal glands could not be differentiated from lymph nodes on MR images in three cases. CONCLUSION: MR imaging is a useful technique for detecting abnormal parathyroid glands preoperatively in patients with recurrent hyperparathyroidism after surgery. The combination of T1- and T2-weighted images increases the sensitivity for detection.

Adult↗
PubMed1993

Thyroid-stimulating hormone activates phospholipase C in normal and neoplastic thyroid tissue.

BACKGROUND: Thyroid-stimulating hormone (TSH) stimulates thyroid growth through two signal transduction pathways: the G protein-adenylate cyclase system and the G protein-phospholipase C (PLC) system. The adenylate cyclase system has been studied extensively, but there is little information available concerning PLC activity in thyroid neoplasms. METHODS: Human thyroid membranes were incubated for 30 minutes at 37 degrees C in the presence or absence of bovine TSH (300 mU/ml). PLC activity was assayed by liberation of inositol phosphates from the enzymatic hydrolysis of tritiated phosphatidylinositol bisphosphate. Fifty-six tissues were assayed (normal, 23; multinodular goiter, 5; follicular adenoma, 9; and differentiated thyroid cancer, 19 [9 low risk and 10 high risk]). RESULTS: TSH significantly increased PLC activity in normal, benign, and most malignant thyroid neoplasms. Although there were no differences in basal or TSH-stimulated PLC activity between the groups of normal thyroid, multinodular goiter, follicular adenoma, or the cancers, one half of the high-risk cancers had an aberrant PLC response. CONCLUSIONS: This is the first demonstration that TSH stimulates PLC activity in normal and neoplastic human thyroid tissue. Aberrant TSH-stimulated PLC activity was present in half of the aggressive thyroid neoplasms.

Enzyme Activation↗
PubMed1992

Normocalcemic hyperparathyroidism. Biochemical and symptom profiles before and after surgery.

Patients with normocalcemic hyperparathyroidism represent a diagnostic and therapeutic challenge. It is unclear to what extent these patients benefit from surgery in terms of correction of their serum chemistry abnormalities and their symptoms. We studied 142 patients: 23 with normocalcemic hyperparathyroidism (serum calcium levels below 2.62 mmol/L), 35 with intermittent hypercalcemia, and 84 with hypercalcemic hyperparathyroidism. Serum chemistry analyses and a standardized questionnaire of symptoms were completed before and after surgery. Overall, patients in the normocalcemic group reported a similar frequency of preoperative symptoms; had a similar reduction in postoperative symptoms; and had a similar normalization of serum calcium, parathormone, and phosphate levels as those in the two control groups. This study indicates that factors other than elevated serum calcium levels are in large part responsible for the symptoms of hyperparathyroidism and that these patients benefit from operation.

Adenoma↗
PubMed1992

Use of color Doppler imaging in the distinction between thyroid and parathyroid lesions.

To determine whether the use of color Doppler imaging in conjunction with standard high-resolution 10-MHz ultrasound could increase the screening sensitivity in distinguishing between thyroid and parathyroid lesions in the detection of parathyroid disease, we studied 32 patients with hyperparathyroidism with both modalities who were subsequently treated surgically. Among these 32 patients, parathyroid lesions were predominantly avascular (n = 21, average size 0.9 x 0.6 cm) but with increased size demonstrated some vascularity (n = 9, average size 2.1 x 1 cm, 32%). Of these 32 patients, 46.6% had thyroid lesions as well. Thyroid lesions were avascular when small (n = 26 lesions, average size 0.5 x 0.5 cm) but tended to demonstrate vascularity (n = 14, 35%) at about 1 cm in size or greater. Although the addition of color Doppler imaging enabled the differentiation of vessel from soft-tissue abnormalities and some distinction between parathyroid and thyroid lesions, it had no effect on overall sensitivity (65%) in the detection of parathyroid disease.

Adult↗
PubMed1992

Hyperparathyroidism in multiple endocrine neoplasia syndrome.

BACKGROUND: We analyzed clinical findings and results of parathyroidectomy in 42 patients treated from 1936 to 1988 at the University of California, San Francisco (UCSF) for primary hyperparathyroidism and multiple endocrine neoplasia (MEN) syndrome to document results of parathyroidectomy and reasons for failed parathyroid operations. METHODS: Of the 42 patients (38 had MEN 1 syndrome; 4 had MEN 2A syndrome), 40 patients were treated surgically: 29 had initial parathyroidectomy at UCSF; 11 were referred to UCSF because of MEN syndrome. Eight of these 11 patients required reoperation for persistent or recurrent hyperparathyroidism. Patients with hyperplasia were treated with subtotal parathyroidectomy; the glands of those patients with solitary or double adenomas were removed with or without biopsy of the normal appearing glands. RESULTS: Overall, in seven (50%) of 14 patients with hyperplasia, three (16%) of 19 patients with solitary adenoma, and one (14%) of seven patients with double adenomas, recurrent or persistent hyperparathyroidism developed. Failure in patients with hyperplasia was due to missed supernumerary glands (13%) and missed ectopic glands (33%). Failure occurred in patients with solitary (three patients) or double (one patient) parathyroid tumors because of unrecognized hyperplasia. None of the four patient with MEN 2A syndrome had persistent or recurrent disease, but hypoparathyroidism developed in one patient; hypoparathyroidism developed in three patients with MEN 1 syndrome. CONCLUSIONS: These data suggest that although many patients with primary hyperparathyroidism and MEN syndrome have multiple abnormal parathyroid glands, two populations of patients exist; one population has solitary or double adenomas and recurrence is uncommon, whereas the other population of patients has hyperplasia and persistent or recurrent disease is common.

Adenoma↗
PubMed1992

Reoperative thyroid surgery.

BACKGROUND: Patients with thyroid cancer are sometimes denied repeat thyroid operations for fear of an increased risk of complications. METHODS: We therefore reviewed our experience in 114 patients with benign or malignant thyroid tumors who underwent 116 thyroid reoperations with or without other procedures. All patients had undergone at least one prior thyroid operation and 16 patients had undergone from two to four thyroid operations before referral. The initial histologic diagnosis before reoperation was thyroid carcinoma in 79 patients, papillary carcinoma in 47 patients, follicular carcinoma in 17 patients, medullary carcinoma in 9 patients, and Hürthle cell carcinoma in 6 patients. Benign disease was present in 35 patients. In 62 patients with cancer, reoperations were performed because of suspected persistent or recurrent disease; one of these patients underwent two reoperations by us. In 17 patients reoperation was to complete total thyroidectomy, primarily so that radioactive iodine could be used to scan for and treat metastatic disease. RESULTS: Among the 116 reoperations, 102 were completion total thyroidectomy, 8 were near-total or subtotal thyroidectomy, and 6 were completion lobectomy. Histologic examination at reoperation revealed thyroid carcinoma in 51 cases (64%) among the 79 patients who had undergone 80 operations for previous thyroid cancer. Recurrent or persistent cancer was present in 49 of 63 (78%) reoperations for patients with papillary, medullary, and Hürthle cell cancer but in only 2 of 17 (12%) patients with follicular cancer. Cancer also occurred in 8 cases (22%) of the 36 reoperations in 35 patients who initially had benign lesions. Complications included one permanent and one transient palsy of the recurrent laryngeal nerve; both occurred on the side of a previous partial or subtotal lobectomy. Other complications included temporary hypoparathyroidism in four patients, seromas in two patients, and a keloid in one patient. CONCLUSIONS: This study documents that reoperations can be performed with minimal morbidity. Thus patients should not be denied the chance to undergo removal of a persistent tumor or the remnant normal thyroid tissue because of the fear of complications.

Adolescent↗
PubMed1991

Calciphylaxis in secondary hyperparathyroidism. Diagnosis and parathyroidectomy.

Calciphylaxis is a rare, severe complication of secondary hyperparathyroidism. Patients present with painful, violaceous, mottled skin lesions of the upper and lower extremities, which become necrotic and produce nonhealing ulcers. Gangrene of fingers and toes frequently requires amputation, produces nonhealing wounds, and can lead to sepsis and death. We reviewed the clinical course of five patients with calciphylaxis treated in our institution. The three men and two women (aged 47 to 72 years) had secondary hyperparathyroidism from chronic renal failure. All patients had severe pruritus, painful ulcers, and severe hyperphosphatemia with elevated serum calcium-phosphate product (greater than 12 mmol2/L2), but the serum parathyroid hormone levels were only moderately elevated. Most patients had medical calcification of medium and small blood vessels, and some had soft-tissue calcification visible on roentgenography. Treatment consisted of local wound care, antibiotics, phosphate-binding agents, and parathyroidectomy. Two patients died of uncontrollable sepsis. The three survivors had dramatic improvement of pain and ulcers after parathyroidectomy. Calciphylaxis is a limb- and life-threatening complication of secondary hyperparathyroidism. Diagnosis can be made by recognizing the characteristic painful skin lesions, ulcers, and gangrene of the digits, and patients should be treated with subtotal parathyroidectomy.

Aged↗
PubMed1991

Diagnosis and management of asymptomatic hyperparathyroidism: safety, efficacy, and deficiencies in our knowledge.

Several recent articles question whether patients with asymptomatic hyperparathyroidism and minimal hypercalcemia should be treated by parathyroidectomy. We therefore reviewed our experience in 103 consecutive patients with primary hyperparathyroidism who were treated by parathyroidectomy to determine, first, how many of these patients had asymptomatic or symptomatic hyperparathyroidism, and second, did these patients benefit from parathyroidectomy? We also analyzed the safety of parathyroidectomy in 426 consecutive patients, including 79 who required reoperation for hyperparathyroidism, specifically looking for complications and the outcome of these procedures. Our study documents the following: (1) only 2 of 103 (2%) patients referred for parathyroidectomy had "true" asymptomatic hyperparathyroidism; (2) only symptoms of fatigue, bone pain, and weight loss correlated with the degree of hypercalcemia, whereas muscular weakness, psychiatric symptoms, nocturia, polyuria, recent memory loss, constipation, and nephrolithiasis did not; (3) only 1 of 15 patients who were referred as asymptomatic were truly asymptomatic after more thorough questioning, and all 14 improved following parathyroidectomy; (4) 81% of the patients who were referred with symptoms improved following parathyroidectomy; and (5) permanent complications occurred in only 4 patients. All but 1 had reoperations for persistent or recurrent hyperparathyroidism (3 vocal cord paralyses and 1 hypoparathyroidism requiring autotransplantation of cryopreserved parathyroid tissue). There was 1 death of an 84-year-old woman with hypercalcemic crisis. Thus, most patients with hyperparathyroidism are symptomatic and benefit symptomatically and metabolically from parathyroidectomy, which is a safe operation.

Female↗