Of 121 patients with primary hyperparathyroidism, 20% demonstrated hyperfunction in more than one parathyroid gland. Patterns of gross enlargement and microscopic hyperplasia varied greatly in patients with multiple parathyroid gland involvement. Persistence of hypercalcemia (2.6% this series) due to failure to remove all abnormal parathyroids is a greater problem than late recurrence (less than 1% this series), which is usually due to a single hyperplastic hyperparathyroid. To minimize persistent or recurrent hypercalcemia as well as permanent postoperative hypoparathyroidism (4% this series), a policy of selective subtotal parathyroidectomy is advocated. Subtotal parathyroidectomy is performed when multiple parathyroids are grossly enlarged or when all parathyroids are slightly enlarged and a fifth parathyroid is not evident, and is planned for conditions predisposing to multiple gland involvement (multiple endocrine adenoma syndrome, familial hyperparathyroidism, mild chronic renal insufficiency).
Block MA, Frame B, Jackson CE, Horn RC. The Extent of Operation for Primary Hyperparathyroidism. Arch Surg. 1974;109(6):798-801. doi:10.1001/archsurg.1974.01360060068018