A profile of patients with hyperparathyroidism undergoing lithium therapy for affective psychiatric disorders

Background Our objective was to evaluate whether lithium‐induced hyperparathyroidism (LIHPT) is caused by single‐gland versus multigland disease. Methods Medical records of 7 patients who underwent parathyroidectomy for LIHPT were reviewed. Results The mean preoperative calcium was 11.1 ± 0.7 mg/dL. Six of 7 patients were rendered eucalcemic with surgery. Of the 6 patients successfully treated with surgery, 4 had single‐gland disease, 1 had double adenomas, and 1 had 4‐gland hyperplasia. Intraoperative intact serum parathyroid hormone (iPTH) accurately predicted resolution of hyperparathyroidism in 6 of 7 patients. One patient then subsequently developed persistent hyperparathyroidism refractory to further surgery. Localization studies defined the extent of disease in 5 of 7 patients. Conclusion LIHPT presents with a spectrum of disease ranging from single‐gland to multigland disease. The utility of preoperative localization studies and intraoperative iPTH in this population is uncertain. Bilateral exploration may be best to achieve a resolution of LIHPT. © 2011 Wiley Periodicals, Inc. Head Neck, 2011