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.