ArticleSurgery2026
Surgery for normocalcemic hyperparathyroidism is safe and effective.
Article in Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe ideal management of normocalcemic primary hyperparathyroidism is controversial and is not discussed in recent guidelines as a result of limited published data. To help fill this knowledge gap, we aimed to report the outcomes of a large case series of patients with normocalcemic primary hyperparathyroidism who underwent parathyroidectomy.
methodsA retrospective review of a prospectively maintained database was conducted to identify patients with normocalcemic primary hyperparathyroidism who underwent parathyroidectomy from 2000 to 2023. A small subset of patients participated in a prospective quality of life pilot study.
resultsIn 554 patients with normocalcemic primary hyperparathyroidism who underwent parathyroidectomy, 89% had clinical manifestations and 58% were caused by multigland disease. Intraoperative parathyroid hormone decrease >50% was achieved in 99% and normal parathyroid hormone levels at 6 months were achieved in 81% of patients. Serious complications were rare. Younger patients had greater rates of transient postoperative hypocalcemia (P < .01). Patients undergoing bilateral exploration were more likely to be Black (P < .01). In participating patients (n = 18), median overall quality of life improved significantly from 29 (interquartile range, 18) preoperatively to 2 (interquartile range, 18) at 2 weeks' postoperatively (P < .001). Each of the individual quality of life subsections including the pain, activities of daily living, occupation, mobility, leisure, general health, and mental function domains all improved significantly after parathyroidectomy (P < .05).
conclusionWe have herein reported the largest institutional case series of patients with normocalcemic primary hyperparathyroidism undergoing parathyroidectomy. Surgery for normocalcemic primary hyperparathyroidism was safe, effective, and, in a prospective pilot study, was associated with significant improvements in quality of life at 2 weeks postoperatively. These findings further support that parathyroidectomy may play an important role in the management of normocalcemic primary hyperparathyroidism.
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