Hyperparathyroidism: experiences with treated and untreated patients.

During a seven-year period, after the introduction of parathyroid hormone assays, 113 patients with primary hyperparathyroidism were seen at an Australian teaching hospital. In 68, parathyroidectomy was followed by normalization of serum calcium levels. Fifteen patients (six referred from other units) remained hypercalcaemic after their initial neck exploration. Thirty patients with biochemical changes indicative of primary hyperparathyroidism were not referred for surgery, mainly because of old age or lack of symptoms. Those patients who were not submitted to surgery, and those who had undergone unsuccessful neck explorations, were observed (while hypercalcaemic) for a mean period of three years. During the period of observation, no deterioration occurred in the clinical or biochemical status of these patients. It is proposed that patients with non-symptomatic primary hyperparathyroidism may be managed by clinical observation, rather than by immediate parathyroidectomy.