Hyperparathyroidism Treatment: an Experience from a Center in the North of Italy with more than 1500 Operations

Our experience regarding HPT began in 1975 with the treatment of secondary HPT. Now the interventions for secondary and tertiary HPT are more than 900. In this paper we only treat primitive HPT, 1531 patients operated until the end of 2012. This experience was divided into two periods, the first from 1975 to 1995 (277 patients) and the second from 1996 to 2012 (1254 patients); this allows us to make some observations. The most important is the use of intraoperative PTH. Even when there is a perfect correlation between ultrasound and scintigraphy, the MGD is present in 12.7% of cases in our experience. But the most interesting is the decrease of PTH. In 5.1% of these cases, a decline of more than 50% was obtained, but not in the normal range, so we explore the other side of the neck through the same incision and a MGD was present. We did not find MGD when the PTH was in the normal range. In conclusion, in agreement with several recent papers (Moalem, Mc Gill, Norman, Mazzaglia, Harari, Slepavicius, Nagar, Yavuz) on the surgical treatment of HPT, we believe it should be made a reflection on what constitutes the best approach for this condition in order to offer to the patients the best chance of a definitive cure. A reassessment of the exploration of all the glands associated with a better interpretation of the results of the intraoperative PTH (return to normal or a progressive fall after another 10 minutes) in our opinion seems to be the best attitude.