Introduction: An audit of outcomes and indications for parathyroidectomy was conducted from April 2016 to April 2018 for all patients had primary hyperparathyroidism at East Sussex Hospitals Trust.
Methods: Clinical notes, pathology results and radiology results were accessed to compile the dataset. Indications for surgery were based on the National Institute of Health criteria for parathyroidectomy in hyperparathyroidism from 2013.
Results: 62 patients were included in this audit (76% female). Most patients were aged 5079 (79%) but the range was from 19 to 84. The most common presentation was as an incidental finding (44%) followed by bone pain (16%) and lethargy 13%). The average corrected calcium at presentation was 2.83 (range 2.583.30) with an average duration of hypercalcaemia of 35 months (range 4100). 58 patients (94%) had urinary calcium measured and 29% fractional excretion of calcium. 61 patients (98%) had at least one NIH criteria for parathyroidectomy. Imaging showed that the US was positive in 56 (90%) patients, MIBI/SPECT 60 (97%) patients with localisation in 58 (94%) patients. There was a 92% correlation between imaging and surgical localisation. 59 (95%) patients had minimally invasive surgery and all were followed up by the surgeon and endocrinology. 53 patients had resolution of hypercalcaemia with surgery. 7 patients had second surgery with calcium normalisation and 2 were on the waiting list for redo surgery. 1 (1.6%) patient had malignancy while 61 (98.6%) had an adenoma. 1 patient suffered with vocal cord palsy that resolved within 2 months.
Conclusion: Since the last audit radiographic and surgical concordance has increased with the use of SPECT/MIBI from 92% to 94%. Surgical success increased from 93% to 97%.