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, assessing vocal cord function should be considered. Causes of failure include missed adenoma in a normal location, ectopic glands, inadequate resection in multiglandular disease, and supernumerary glands.