Exploring surgical failures in primary hyperparathyroidism

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Published Nov 9, 2025
https://doi.org/10.62438/tunismed.v103i9.5584
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Vol. 103 No. 9 (2025): Tunis Med sept 2025

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Azza Mediouni
ENT department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, postal code 1007, Tunis, Tunisia.
Maamoun Kriaa
ENT department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, postal code 1007, Tunis, Tunisia.
Maha Mejbri
ENT department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, postal code 1007, Tunis, Tunisia.
Rihab Lahmer
ENT department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, postal code 1007, Tunis, Tunisia.
Maissa Lajhouri
ENT department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, postal code 1007, Tunis, Tunisia.
Houda Chahed
ENT department, La Rabta Hospital, Faculty of Medicine of Tunis, University of Tunis el Manar, postal code 1007, Tunis, Tunisia.

Abstract

Introduction: Parathyroidectomy is considered the most cost-effective treatment for primary hyperparathyroidism (PHPT), with a relatively low incidence of complications. Nonetheless, 5-10% of patients do not achieve cure after initial parathyroidectomy. We hereby report our experience to determine the causes of our uncured patients and explore factors that could be associated with failure.


Methods: We conducted a retrospective case series study and reviewed all the patients who underwent surgery for PHPT from 2004 to 2020. Cure was defined as re-establishment of normal calcium homeostasis lasting a minimum of 6 months. Persistent PHPT (perPHPT) was defined as ongoing hypercalcemia at any time within the 6 months after surgery.


Results: The overall failure-to-cure rate was 6%. Of the 165 patients, 155 underwent successful surgical treatment of PHPT at the initial operation and perPHPT occurred in 10 patients. Baseline factors including age, sex, preoperative laboratory values, imaging, and surgical approach did not differ significantly between cured and non-cured groups. The sensitivity of intraoperative PTH measurement (iOPTH) as an indicator of operative success was 88,5%. Of the 10 patients with perPHPT, multi-gland disease (MGD) was present in 7 and ectopic adenoma in one. The lack of iOPTH use contributed to failure in 2 cases.


Conclusion: Our study underscores the critical role of MGD as a significant cause of perPHPT. Other etiologies may include ectopic glands or technical problems during surgery. The use of iOPTH is crucial in reducing the incidence of perPHPT and should be a routine practice.

Keywords:

Primary hyperparathyroidism, Parathyroid hormone, Parathyroid Glands, Parathyroidectomy, Treatment Failure

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