Surgical management of hyperparathyroidism

Hyperparathyroidism is a single-gland disease in 80--90% of cases. About one-half of the patients surgically treated are asymptomatic, but the risk of complications is great enough to justify cervical exploration in most cases. Using knowledge of embryology and anatomy for exploration of the parathyroid glands the surgeon can locate the pathological tissue in 95% of cases without the use of sophisticated tests. Once the disease has been treated the recurrence rate of hypercalcaemia is no more than 1%. When hyperplasia is the underlying pathological condition subtotal parathyroidectomy, or resection of 3 1/2 glands, is indicated. Every attempt should be made to reduce the incidence of permanent hypocalcaemia as a complication of treatment and to keep surgical mortality near zero.