Unilateral Focused Parathyroidectomy versus Bilateral Neck Exploration in Primary Hyperparathyroidism: A Retrospective Cohort Study

Abstract

1.Background: Primary hyperparathyroidism (pHPT) is cured by parathyroidectomy. Bilateral neck exploration (BNE) has been the historical standard, whereas improved preoperative imaging and intraoperative parathyroid hormone (IOPTH) monitoring support unilateral focused parathyroidectomy (UFP) in selected patients. This study compared UFP and BNE. 2. Methods: We conducted a single-center retrospective cohort study of adults undergoing initial surgery for sporadic pHPT between 2012 and 2023 with ≥6 months follow-up. Diagnosis was biochemical (hypercalcemia with inappropriately high/unsuppressed PTH). Localization used cervical ultrasound and technetium-99m sestamibi; IOPTH (Miami criterion) was used when available to confirm adequate resection and prompt conversion to wider exploration if needed. 3. Results: Of 84 operated patients, 72 met inclusion criteria (mean age 51.9±14.1 years; 77.8% female). UFP was performed as the first operation in 54 patients (75%) and BNE in 18 (25%). Pathology revealed single adenoma in 66 cases (91.7%), multiple adenomas in 3 (4.2%), and hyperplasia in 3 (4.2%). Eight patients (11.1%) required reoperation, and recurrent disease without further surgery occurred in 2 (2.8%). One patient later developed parathyroid carcinoma with bone metastasis and died. 4. Conclusions: In a cohort largely characterized by single-gland disease, UFP was the predominant approach with low clinical recurrence; BNE remained essential for non-localizing or complex disease.