Dynamics Of Immediate And Long-Term Results Of Patients With Typical And Atypical Forms Of Primary Hyperparathyroidism In The Republic Of Uzbekistan

Abstract

The aim of the study: - to study the dynamics of the immediate and long-term results of patients with typical and atypical forms of primary hyperparathyroidism            

Material and research methods: The work was performed in the Department of Surgery of the RSSPMCE named after. akad E.H. Turakulov and based on the analysis of the results of the study and treatment of 225 patients diagnosed with primary hyperparathyroidism who were on inpatient treatment for the period 2005-2022. The average age of the patients ranged from 13 to 75 years (44.02±0.8 years).

A comparative analysis of the results of laboratory and instrumental studies was carried out. Among the biochemical and hormonal tests, the analysis of parathyroid hormone (PTH) in blood serum, calcium, phosphorus, alkaline phosphatase (ALP), Ca++, P, beta cross laps, parathyroid hormone (PTH), vitamin D3 was carried out both at the preoperative stage and to monitor the outcome of surgical and conservative treatment in the postoperative period.

Blood was determined before and 1 day after surgery in all patients.

       Instrumental research methods included ECG, ultrasound of the parathyroid, body X-ray densitometry, radioisotope scintigraphy and SPECT with Tс99.

Results. 1. The high level of PTH in our studies, when compared with the norm, was determined in 89% of patients with PHPT. It was the levels of PTH, Ca++, and urine Ca that largely served as differential diagnostic criteria and tipped the scales in favor of establishing a diagnosis of PHPT. The level of Ca++ was increased in 83.5% of patients with PHPT (p<0.001).

       Changes in densitometry were more pronounced in patients of both groups, but dominated in patients with an atypical form of PHPT.       

        2.In both groups of patients, the average values of PTH, vit D3 and the Beta-Cross Laps bone marker significantly approached the normal limits by 6 months after parathyroidectomy and after 5 years remained at the same level (p< 0.05). The study of changes in BMD according to densitometry at various times after parathyroidectomy surgery in the study groups showed that this treatment is highly effective and contributes to the normalization of bone metabolism in patients with both forms of PHPT within the first year.  At the same time, the atypical form of PHPT is restored somewhat later.

       3.In general, the analysis of immediate and long-term results confirmed the high efficiency of PTE surgery in patients with PHPT and the presence of a persistent effect in the long-term period