Heralds a new era in the treatment of primary hyperparathyroidism

Primary hyperparathyroidism is a more prevalent condition than many perceive. The overall incidence is 25 per 100 000 of the United Kingdom's population.1 However, in women over the age of 45 it may affect one in 500, and more than 1% of post-menopausal women have raised serum concentrations of calcium.2 Parathyroidectomy is the treatment of choice in symptomatic primary hyperparathyroidism. It cures fatigue and the bone, abdominal, urological, and mental symptoms associated with hypercalcaemia. Parathyroidectomy also results in a quantifiable improvement in health related quality of life.3 Additionally a 25 year follow up of patients with untreated “asymptomatic disease” showed a notable increase in cardiovascular deaths compared with age matched normocalcaemic controls.2 Support for an operative approach is further provided by lack of an effective medical treatment and the cost and doctor hours involved in the follow up of conservatively managed patients.

Traditionally parathyroidectomy involves a collar incision, bilateral exploration of the neck, identification of all four parathyroid glands, and removal of the diseased gland or glands. This approach, in experienced hands in large volume centres, has enabled cure rates of up to 97% with minimal morbidity, …