ADVANTAGES
OF SURGERY IN ASYMPTOMATIC PRIMARY HYPERPARATHYROIDISM
Parathyroidectomy
removing all the hyperfunctiong parathyroid parenchyma achieves permanent cure
of the disease, improves bone density and ameliorates vague clinical
symptomatology (such as fatigue, sense of weakness, mild depression, memory impairment
and cognitive dysfunction), thereby improving quality of life. Accurate preoperative
localization allows a minimally invasive approach (focused parathyroidectomy),
which is associated with less tissue dissection, less pain, less morbidity, and
a better aesthetic outcome. Postoperative recovery is fast and the patient is
ready to return to his/her usual activities within only a few (2 – 3) days. In
contrast, without surgery, disease progression will be observed in at least one
third of patients during the first few years of observation, as evidenced by
worsening of hypercalcemia/hypercalciuria and/or development of nephrolithiasis
(newly diagnosed). Moreover, the cost of prolonged follow-up and repeated
diagnostic tests/examination may ultimately exceed the cost of surgery. The age
is an important parameter and surgery should be strongly considered in young
patients (< 50 yrs). Despite that specific criteria for surgery have been
proposed for the management of asymptomatic PHPT (Fourth
International Workshop on Asymptomatic Primary Hyperparathyroidism, 2014),
many patients with asymptomatic PHPT who do not meet these surgical
intervention criteria may still prefer parathyroidectomy
because it is the only definitive
(simple and effective) therapy. Experience in endocrine surgery is required
from the part of the surgeon in order to achieve permanent cure during the initial
surgery, thereby avoiding the development of recurrent/permanent
hyperparathyroidism, which may require reoperation(-s).
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