Surgery for normocalcemic hyperparathyroidism is safe and effective.

Abstract

The ideal management of normocalcemic primary hyperparathyroidism is controversial and is not discussed in recent guidelines as a result of limited published data. To help fill this knowledge gap, we aimed to report the outcomes of a large case series of patients with normocalcemic primary hyperparathyroidism who underwent parathyroidectomy. A retrospective review of a prospectively maintained database was conducted to identify patients with normocalcemic primary hyperparathyroidism who underwent parathyroidectomy from 2000 to 2023. A small subset of patients participated in a prospective quality of life pilot study. In 554 patients with normocalcemic primary hyperparathyroidism who underwent parathyroidectomy, 89% had clinical manifestations and 58% were caused by multigland disease. Intraoperative parathyroid hormone decrease >50% was achieved in 99% and normal parathyroid hormone levels at 6 months were achieved in 81% of patients. Serious complications were rare. Younger patients had greater rates of transient postoperative hypocalcemia (P < .01). Patients undergoing bilateral exploration were more likely to be Black (P < .01). In participating patients (n = 18), median overall quality of life improved significantly from 29 (interquartile range, 18) preoperatively to 2 (interquartile range, 18) at 2 weeks' postoperatively (P < .001). Each of the individual quality of life subsections including the pain, activities of daily living, occupation, mobility, leisure, general health, and mental function domains all improved significantly after parathyroidectomy (P < .05). We have herein reported the largest institutional case series of patients with normocalcemic primary hyperparathyroidism undergoing parathyroidectomy. Surgery for normocalcemic primary hyperparathyroidism was safe, effective, and, in a prospective pilot study, was associated with significant improvements in quality of life at 2 weeks postoperatively. These findings further support that parathyroidectomy may play an important role in the management of normocalcemic primary hyperparathyroidism.