[Indications for parathyroidectomy]

The standard of care for primary hyperparathyroidism is surgical removal of all hyperfunctional parathyroid tissue. In experienced hands, parathyroidectomy is successful in 95-99% of cases with a very low complication rate. Surgery is indicated for all patients with symptomatic primary hyperparathyroidism. Asymptomatic individuals should also be surgically treated when patients are younger than 50 years, have severe hypercalcemia, markedly reduced creatinine clearance and/or profound osteopenia (according to the NIH Consensus Conference 2002). A precise preoperative localisation of parathyroid adenomas using cervical ultrasound and Sestamibi scintigraphy enables to elect the minimally invasive parathyroidectomy in most of the cases. Nowadays, the former routine of open bilateral cervical exploration is indicated only if preoperative localisation was not successful and hyperplasia of all four parathyroid glands is anticipated.