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options for treatment of persistent or recurrent hyperparathyroidism Although preoperative localization is optional prior to an initial surgery for HPT, it is essential in cases of persistent or recurrent disease because the success rate of the surgery is much higher when the abnormal gland has been accurately localized. Multiple modalities are often utilized with 99m …

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Approach to patients with persistent or recurrent hyperparathyroidism The approach to patients with persistent or recurrent hyperparathyroidism requires confirmation of the diagnosis (exclude familial hypocalciuric hypercalcemia, vitamin D deficiency, etc.), estimation of disease severity to ensure that reoperation is justified, careful review of the operative and pathology reports, and preoperative localization. If undergoing repeat operation, …

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What is the most common cause of an elevated serum PTH with normal serum calcium after parathyroidectomy? Persistent PTH elevation with normal serum calcium can be observed in up to 30% of patients after parathyroidectomy. This can be disconcerting to the patient and the surgeon, but in the vast majority of cases, it is not …

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Persistent and recurrent hyperparathyroidism Persistent hyperparathyroidism is defined as failure of calcium and PTH levels to normalize or remain normal in the initial 6 months after operation, whereas recurrent hyperparathyroidism is defined as recurrence of hypercalcemia after 6 months.

Complications of parathyroidectomy for primary hyperparathyroidism and their prevalence Persistent hyperparathyroidism: < 5% Recurrent hyperparathyroidism: 5% to 10% Transient hypocalcemia: 10% to 25% Permanent hypoparathyroidism: 2% to 5% (< 1% for solitary adenoma) Temporary recurrent laryngeal nerve injury: 3% Permanent recurrent laryngeal nerve injury: < 1% Mortality: < 0.1%

What are the indications for surgery for tertiary hyperparathyroidism? Although all patients with dialysis-dependent renal failure develop secondary hyperparathyroidism, only a minority of patients develop tertiary hyperparathyroidism, which develops when somatic mutations occur within one or more of the hyperplastic parathyroids resulting in adenomatous transformation. Medical management with phosphate binders, active vitamin D analogues (calcitriol), …

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Multiglandular parathyroid disease A single adenoma is, by far, the most common cause of primary HPT (85%). Depending on the method used to define multiglandular disease (i.e., ioPTH assay versus gross appearance/size), the reported rates range from 5% to 35%. Multiglandular disease can be caused by either multiple adenomas or four-gland hyperplasia. Hyperplasia may be …

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