Department of Surgery, Höglandssjukhuset Eksjö, Eksjö, Sweden.
Br J Surg. 2010 Nov;97(11):1680-5. doi: 10.1002/bjs.7199.
Lithium therapy for affective bipolar disease is frequently associated with hyperparathyroidism (HPT), but the results of surgical treatment are virtually unknown. The aim of this retrospective review was to analyse the long-term outcome after surgery for lithium-induced HPT in a large series of patients.
Seventy-one patients on chronic lithium therapy who underwent surgery in three university and three district hospitals in Sweden were followed for a median of 6.3 years. Histopathology, complications of surgery and normocalcaemia at 6 months after surgery and last follow-up were analysed.
The primary histopathological diagnoses were adenoma (45 per cent), double adenomas (3 per cent) and hyperplasia (52 per cent). No permanent paresis of the recurrent laryngeal nerve was recorded but 13 per cent of the patients suffered from permanent hypoparathyroidism. At follow-up, the rate of persistent and recurrent HPT was 42 per cent regardless of the histopathological diagnosis.
The results of conventional surgery for lithium-associated HPT are poor. The surgical approach should be adjusted for the multiglandular disease that is usually the cause of HPT in patients on chronic lithium therapy.
锂治疗情感双相障碍常与甲状旁腺功能亢进（HPT）相关，但手术治疗的结果实际上尚不清楚。本回顾性研究的目的是分析大量锂诱导 HPT 患者手术后的长期结果。
在瑞典的 3 所大学医院和 3 所地区医院，对 71 例接受慢性锂治疗的患者进行了手术治疗，对这些患者进行了中位数为 6.3 年的随访。分析了组织病理学、手术并发症和术后 6 个月及最后一次随访时的血钙正常情况。
原发性组织病理学诊断为腺瘤（45%）、双腺瘤（3%）和增生（52%）。未记录到永久性喉返神经麻痹，但 13%的患者发生永久性甲状旁腺功能减退。随访时，无论组织病理学诊断如何，持续性和复发性 HPT 的发生率均为 42%。
针对锂相关性 HPT 的常规手术治疗效果不佳。对于慢性锂治疗患者中通常导致 HPT 的多腺体疾病，手术方法应进行调整。
