A profile of patients with hyperparathyroidism undergoing lithium therapy for affective psychiatric disorders

Background. Our objective was to evaluate whether lithium-induced hyperparathyroidism (LIHPT) is caused by single-gland versus multigland disease. Methods. Medical records of 7 patients who underwent parathyroidectomy for LIHPT were reviewed. Results. The mean preoperative calcium was 11.1 � 0.7 mg/dL. Six of 7 patients were rendered eucalcemic with sur- gery. Of the 6 patients successfully treated with surgery, 4 had single-gland disease, 1 had double adenomas, and 1 had 4-gland hyperplasia. Intraoperative intact serum parathyroid hormone (iPTH) accurately predicted resolution of hyperpara- thyroidism in 6 of 7 patients. One patient then subsequently developed persistent hyperparathyroidism refractory to further surgery. Localization studies defined the extent of disease in 5 of 7 patients. Conclusion. LIHPT presents with a spectrum of disease ranging from single-gland to multigland disease. The utility of preoperative localization studies and intraoperative iPTH in this population is uncertain. Bilateral exploration may be best to achieve a resolution of LIHPT. V C 2011 Wiley Periodicals, Inc. Head Neck 33: 925-927, 2011