How is a missing parathyroid managed

Appropriate management of a missing parathyroid

Despite meticulous operative technique during conventional parathyroidectomy (identification of all four glands), the surgeon occasionally encounters a “missing gland.” Up to 20% of parathyroid glands are ectopic, with the most common locations being within the thymus, retroesophageal, and intrathyroidal. A systematic search of the most common ectopic locations is required for successful outcome in these patients. When three normal glands have been identified and the fourth gland is not in a normal position, the most likely ectopic location depends on whether the upper gland or the lower gland is missing.

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