Parathyroid Surgery Outcome at King Salman Armed Forces Hospital

Introduction: The aim of this study is to review the surgical outcome of parathyroidectomy at one institution over nine years in form of methods of diagnosis, type of surgery, postoperative complications and histopathology findings. Methods: This is a retrospective study from a single institution (King Salman North West Armed Forced Hospital (KSAFH), Tabuk, Saudi Arabia). All cases underwent parathyroidectomy from 1/1/2010 until 31/12/2018 were retrieved from the archives of the department of surgery. Data were extracted from the patients’ charts. They included demographical data, presence of comorbidities, laboratory and radiological investigations, type of surgery, postoperative complications and histopathology findings. Inclusion criteria include patients older than 13 years old. Exclusion criteria include patients younger than 13 years old, hyperparathyroidism cured with medication, patients unwilling to give informed consent and patients with serious underlying medical condi-tions that restrict diagnostic testing or therapy such as congestive cardiac fail-ure. Results: A total of 30 patients underwent parathyroidectomy at KSAFH. 20 out of 30 patients were female (66.7%). The mean age was 35 - 45 years old. Diabetes mellitus was found in 5 patients (16.7%), while hypertension was seen in 10 patients (33.3%). 6 patients (20%) had end stage renal disease (ESRD). The data showed 24 patients with primary hyperparathyroidism (80%), 5 patients with secondary hyperparathyroisim (16.7%) and one patient with tertiary hyperparathyroidism (3.3%). Our study demonstrated that 23 patients underwent partial parathyroidectomy (76.6%), while 7 patients underwent total parathyroidectomy (23.3%). According to the method used for diagnosis of hyperparathyroidism, blood tests were used in 27 patients (90%), Sestamibi parathyroid scan in 26 patients (86.6%), ultrasound scanning in 28 patients (93.3%) and bone scan in 9 patients (30%). Sensitivity of Sestamibi scan in primary hyperparathyroidism (91.7%) and (66%) for secondary hyperparathyroidism. Mean operative time was 79 minutes. Mean hospital stay was 4


Introduction
The main benefit of treating hyperparathyroidism with parathyroidectomy is potential to treat signs and symptoms of the disease. Primary hyperparathyroidism affects multiple systems of the body. Most patients with primary hyperparathyroidism have significant comorbidities associated with the condition. Patient can be with mild parathyroid disease or severe parathyroid disease and both are likely to benefit from parathyroid surgery. Usually there are improvements in bone disease after parathyroid surgery [1]. Hyperparathyroidism is a disease that is seen often in the United States. Patients may present with a wide variety of symptoms affecting multiple organs, but frequently they are found to be hyperparathyroid on a routine blood examination. Although, these patients may be asymptomatic, new consensus guidelines exist for when they should undergo surgery and several studies have shown multiple benefits from operative intervention [2]. The aim of this study is to describe the outcomes of parathyroidectomy in King Salman Armed Forces Hospital (KSAFH), Tabuk, Saudi Arabia.

Methods
Approval was obtained from the local ethical and research committee. This was a retrospective randomised study. Demographic data of patient collected presence of comorbidities reported and surgical complication reported. We reviewed the medical records of patients who underwent parathyroid surgery in King Salman Armed Forces Hospital, Tabuk, Saudi Arabia from 1/1/2010 till 31/7/2018 with minimum 12 -24 months follow up. Our aim to compere between outcome of parathyroid surgery with regard to comorbidities, method of diagnosis, typer of surgery, operative time, complication rate, rate of cure, recurrence rate and histopathological finding. Our inclusion criteria were age more than 13 years and post parathyroid surgery. Exclusion criteria less than 13 years, hyperpara-

Operative Description
In bilateral exploration, a transverse low collar incision is made about one finger wide above the clavicular head in an existing skin crease. The dissection is carried down through the subcutaneous tissue and the platysma muscle. Hemostasis is obtained by electrocautery or ligation using ties.

Discussion
Parathyroidectomy is the definitive therapy for primary hyperparathyroidism but may also be necessary in secondary or tertiary hyperparathyroidism. Bilateral neck exploration is the standard operation, especially optimal for patients who have multiple gland disease or non-localizing preoperative imaging studies. With improved preoperative localization techniques and intraoperative PTH monitoring, minimally invasive parathyroidectomy is widely used in unilateral exploration. Even a four-gland exploration can be performed in a minimally invasive fashion [5]. Surgery of primary hyperparathyroidism is the only curative thera- hyperparathyroidism, parathyroidectomy results in the normalization of biochemical values and increased bone mineral density. Most asymptomatic patients who did not undergo surgery did not have progression of disease, but approximately one quarter of them did have some progression [4]. Drawbacks of our study were single center, nonrandomized, biased selection, small size and short follow up.

Conclusion
Hyperparathyroidism is more common in female patients than male patients.
High sensitivity for sestamibi scan in primary hyperparathyroidism. ESRD is the most common cause of secondary hyperparathyroidism. Most common complication is hypocalcemia. High rate of cure following parathyroid surgery.