Surgical management of parathyroid disease

One hundred fifty patients who had operation for hyperparathyroidism at the National Institutes of Health are reviewed. The series is composed of several groups of patients, including 18 with normocalcemic hyperparathyroidism, 13 with hyperparathyroidism associated with MEA II, and 24 patients with a history of previous parathyroid operation. Selective venous catherization and radioimmunoassay of parathormone was carried out in 81 patients and was interpreted as being localizing in 65 cases. Following operation, six patients remained hypercalcemic. There were nine instances of permanent hypocalcemia and four cases in which permanent recurrent nerve injuries were experienced. The operative management of these patients is outlined in detail, stressing an approach which includes the surgeon, the internist and the pathologist. Based upon pathological evidence, the importance of identifying by frozen section four glands is emphasized.