Parathyroidectomy outcomes and pathology in primary hyperparathyroidism

Complications related to parathyroid surgery are rare but most commonly include recurrent laryngeal nerve injury, hematoma formation, and hypocalcemia. In highly experience centers, >95 % of patients are normocalcemic postoperatively. Parathyroid hormone (PTH) on the other hand remains elevated in a significant number of patients with normocalcemia after parathyroidectomy. Primary hyperparathyroidism (PHPT) is due to a single parathyroid adenoma in most patients, with a chief cell adenoma being the most common pathologic variant. However, oxyphil adenomas, lipoadenomas, clear cell adenomas, and atypical parathyroid adenomas can also be seen. Parathyroid carcinoma and parathyromatosis are other pathologic entities that should be considered in persistent and recurrent PHPT. Parathyroid hyperplasia is the cause of PHPT in approximately 15 % of patients and is seen in familial parathyroid disorders such as MEN1, MEN2A, MEN4, hyperparathyroidism-jaw tumor syndrome, and familial isolated PHPT.