Parathyroid Surgery in the Multiple Endocrine Neoplasia Type I Syndrome: Choice of Surgical Procedure

Thirty-nine patients with hyperparathyroidism (HPT) in association with the multiple endocrine neoplasia type I (MEN-I) syndrome underwent parathyroid surgery from 1961 to 1985. Twenty-one patients underwent resection of 1–21/2 glands, 6 had 3–31/2 glands removed, and 18 (9 of whom had previously been subjected to parathyroid surgery) underwent total parathyroidectomy with autotransplantation to the forearm. Resection of 1–21/2 glands resulted in persistent or recurrent HPT in 18 (88%) of the 21 cases. Two (33%) of the 6 patients who underwent 3–31/2-gland resection had recurrent disease. After total parathyroidectomy with autotransplantation to the forearm, no patient had persistent or recurrent HPT. Five (26%) of 18 patients had permanent hypocalcemia requiring supplemental therapy. After a change in the operative technique, however, only 1 of 10 was permanently hypocalcemic. It is concluded that primary HPT in the MEN-I syndrome always should be treated with radical surgery. Total parathyroidectomy with autotransplantation seems more favorable than 3–31/2-gland resection owing to the absence of recurrent HPT in this material and the limited number of patients with long-standing postoperative hypocalcemia, provided that an optimal technique for autotransplantation was performed.