Long Term Results of Different Techniques

About 95% of patients with primary hyperplasia improve,69 and most patients with secondary HPT also experience dramatic clinical improvement (see Table 53-3). Lundgren and coworkers61 reported a 73% incidence of permanent hypocalcemia after total parathyroidectomy with autotransplantation. Rothmund and others52,5670 reported no difference in the incidence of hypocalcemia after total or subtotal parathyroidectomy, but the number of patients was small and follow-up time was short.53 Mozes and coworkers in 1980 reported that 25% of their patients experienced late failure of the parathyroid graft.68 These data, we believe, support subtotal parathyroidectomy for most patients. None of our patients have experienced permanent hypoparathyroidism, although recurrent HPT has occurred. The relative incidences of complications after total and subtotal parathyroidectomy are documented in Tables 53-1 and 53-2.

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