Analysis Of The Clinical Data Of Primary Hyperparathyroidism

Objective : To analyze the clinical data of patients with primary hyperthyroidism(PHPT), to explore the clinical features, diagnostic methods, treatment strategies and prognosis evaluation, and to provide evidence for evidence-based medicine for the standardized diagnosis and treatment of PHPT.Method: Retrospective analysis of 43 cases of primary hyperthyroidism which accepted open surgery treatment between January 2013 to December 2015 in the Department of Thyroid Surgery China-Japan Union Hospital Jilin University. Compared with the general clinical data, preoperative parathyroid related laboratory indexes, preoperative imaging data, surgical and pathological results, postoperative laboratory indexes, etc.Results: The study of 43 patients with PHPT patients were diagnosed, 40 cases were parathyroid adenoma(93.02%) and 3 cases were parathyroid carcinoma(6.98%), including 30 female cases(69.77%) and 13 male cases(30.23%), and the proportion of female patients who have adenoma and adenocarcinoma are larger than males, but the difference between them was not statistically significant(P > 0.05). Age of onset are between 41-60 years old. the total number of patients are 31(72.09%); the average age of onset female who have adenoma was 51.03 + 10.41, and 41.40 + 11.87 for men, the difference was statistically significant(P = 0.030); adenoma and adenocarcinoma cancer group, the age at disease onset and disease duration differences were not statistically significant(P > 0.05).In clinical types, no symptoms was most which had 20 cases(46.51%), 9 cases(20.93%) of renal bone type, 7 cases(16.28%) of renal type, 6 cases(13.95%) of bone type, and 1 case(2.33%) of hypercalcemia type. Preoperative serum calcium, PTH and ALP that the average level was 3.04 + 0.39mmol/L, 719.99 + 625.36pg/ml and 460. 17 + 660.39IU/L respectively. Comparison of adenoma and adenocarcinoma group preoperative serum calcium, PTH and ALP differences had no statistical significance(P > 0.05); asymptomatic patients with preoperative serum calcium and PTH were lower than those of patients with symptoms, the difference were statistically significant(P < 0.05); radionuclide scan which negative in patients with preoperative PTH were lower than positive patients, the difference was statistically significant(P = 0.003) and nuclide scan which negative in patients with preoperative calcium was less than the positive patients, but the difference was not statistically significant(P = 0.168). The sensitivity of the neck color Doppler ultrasound diagnosis and preoperative radionuclide scan was 71.43% and 81.40% respectively, and the sensitivity of the combined application was 83.33%. The incidence of inferior parathyroid lesions(30, 75%) was higher than that of the upper parathyroid glands(10, 25%), and the coincidence rate was 97.62%. The 50% attenuation rate of PTH after surgical resection of the diseased glands 15 min, 30 min was 92.68% and 95.24% respectively, and 50% attenuation rate of PTH was 100% when patients discharged. Postoperative 1 day, 3 days and discharge, the serum calcium fell to below the normal high limit were 83.72% and 88.10% and 100% respectively, postoperative first day appeared low calcium has 7 cases(16.28%), discharged has 5 cases(11.63%), and the minimum value of blood calcium was 2.02mmol/L when discharged. 23 cases were followed up, and the symptoms were improved in different degree, and no recurrence was found.Conclusion: 1. PHPT patients were inclined to the female, the incidence of the patient’s age is concentrated in the 40 to 60 years old. 2. Most pathologic type of PHPT was adenoma, the mainly clinical types was no symptoms, different types of pathology have no effect on the age of onset and course of disease, the incidence of male patients with adenoma is lower than that of female patients; 3. Preoperative serum calcium and PTH and ALP have varying degrees of increase, but patients of different pathological type serological index did not differ, type symptoms in patients with serum calcium and PTH were higher than those of asymptomatic; 4. Ultrasound and radionuclide scanning are important methods of PHPT location diagnosis, the combination of both can improve the sensitivity of the diagnosis. 5. The incidence of parathyroid lesions was higher than that of the upper parathyroid gland. 6. Operation is an effective method for the treatment of PHPT, PTH detection can effectively predict the success rate of surgery.