Hyperparathyroidism--patterns of presentation, symptoms and response to operation.

Forty-three patients operated upon for hyperparathyroidism over a 7-year period are reviewed with reference to modes of presentation, symptoms and symptomatic response following operation (76% of symptoms cured or improved). The patterns of presentation are discussed in relation to the increasing use of routine biochemical screening; emphasis is given to the symptoms admitted by 17 so-called 'asymptomatic' patients diagnosed in this way and to their improvement following surgery (75% of symptoms). Symptomatic improvement among a similar group of seventeen 'asymptomatic' patients undergoing operations for thyroid swellings was observed in only 9% of symptoms. In the light of such subjective improvement following parathyroidectomy, the theoretical prophylactic benefit of operation and its lack of morbidity, an aggressive surgical approach to the disease is considered justified.