Factors associated with late recurrence after parathyroidectomy for primary hyperparathyroidism

Abstract Background A recent study with unusually lengthy follow-up after surgery for primary hyperparathyroidism reported higher recurrence rates than previously appreciated. We sought to identify specific factors associated with late recurrence after seemingly curative parathyroidectomy. Methods Prospectively collected data were retrieved for patients who had surgical treatment of sporadic primary hyperparathyroidism with ≥ 3-year follow-up (3–17.6 years). Recurrence was defined by 6 months of eucalcemia with subsequent hypercalcemia and a high or unsuppressed parathyroid hormone. Recurrent patients were compared with cured patients (defined by consistent eucalcemia). Results Among 261 patients, 28 (10.7%) had recurrence and 233 (89.3%) were cured. The mean time to recurrence was 77 months (range 13–170). The mean final intraoperative parathyroid hormone (49.0 pg/mL vs 37.5 pg/mL, P Conclusion Long-term follow-up after apparent curative surgery for primary hyperparathyroidism identified a high late recurrence rate (10.7%), up to 17 years later. A 6-month calcium >9.7 mg/dL and eucalcemic parathyroid hormone elevation at 6 months may be associated with recurrence, and such findings may help guide management.