Predictors of single-gland vs multigland parathyroid disease in primary hyperparathyroidism: a simple and accurate scoring model

Arch Surg. 2006 Aug;141(8):777-82; discussion 782. doi: 10.1001/archsurg.141.8.777.


Hypothesis: Preoperative clinical, biochemical, and imaging studies could be used to reliably select patients with single-gland primary hyperparathyroidism who could undergo minimally invasive parathyroidectomy and to determine whether additional perioperative testing is necessary.

Design: Retrospective analysis.

Setting: Tertiary referral center.

Patients: A total of 238 patients who underwent neck surgical exploration and parathyroidectomy for primary hyperparathyroidism from January 7, 2002, to December 23, 2004.

Main outcome measures: Demographic, clinical, biochemical, and imaging factors that predict single-gland vs multigland parathyroid disease, and biochemical cure.

Results: Of the 238 patients, 75.2% had a single adenoma, 21.4% had asymmetric 4-gland hyperplasia, and 3.4% had double adenomas. A biochemical cure was achieved in 99.2% of the patients. Preoperative calcium and intact parathyroid hormone levels were significantly higher (P = .03 and .04, respectively) and ultrasound and sestamibi scan results were more likely to be positive (both P<.001) in single-gland primary hyperparathyroidism. A dichotomous scoring model based on preoperative total calcium level (>/=3 mmol/L [>/=12 mg/dL]), intact parathyroid hormone level (>/=2 times the upper limit of normal levels), positive ultrasound and sestamibi scan results for 1 enlarged gland, and concordant ultrasound and sestamibi scan findings reliably distinguished single-gland vs multigland cases (P<.001). The positive predictive value of this scoring model to correctly predict single-gland disease was 100% for a total score of 3 or higher.

Conclusions: Preoperative biochemical and imaging study results reliably distinguished single-gland vs multigland parathyroid disease in primary hyperparathyroidism. Our findings suggest that patients with a score of 3 or higher can undergo a minimally invasive parathyroidectomy without the routine use of intraoperative parathyroid hormone or additional imaging studies, and those with a score of less than 3 should have additional testing to ensure that multigland disease is not overlooked.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Calcium / blood
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperparathyroidism, Primary / blood
  • Hyperparathyroidism, Primary / diagnosis*
  • Hyperparathyroidism, Primary / surgery
  • Male
  • Middle Aged
  • Parathyroid Glands / diagnostic imaging
  • Parathyroid Glands / surgery
  • Parathyroid Hormone / blood
  • Parathyroidectomy / methods*
  • Preoperative Care
  • Prognosis
  • ROC Curve
  • Radionuclide Imaging
  • Retrospective Studies
  • Severity of Illness Index
  • Ultrasonography


  • Parathyroid Hormone
  • Calcium