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Clinical Challenges
September 1998

Surgical Management of Primary Hyperparathyroidism: Review of My Experience at the University of Vermont

Author Affiliations


Arch Otolaryngol Head Neck Surg. 1998;124(9):1056. doi:10.1001/archotol.124.9.1056

THE CURRENT surgical management of primary hyperparathyroidism can be viewed from the 3 following perspectives: (1) bilateral cervical exploration without preoperative localization, (2) unilateral surgery with the aid of preoperative 99Tc sestamibi scanning, and (3) focused unilateral surgery with intraoperative PTH assay. Bilateral cervical exploration without preoperative localization has been the criterion standard of management for decades, and is emphasized by the often paraphrased quotation "The best localization study for a parathyroid adenoma is an experienced endocrine surgeon." That comment may have been completely logical in an era when nuclear localization methods, such as technetium thallium and 5-MHz transducer probes for ultrasonography, did not produce reliable, cost-effective answers. Even with precise localization information, bilateral exploration is still the foundation of good parathyroid gland surgery. Parathyroid hyperplasia, small adenomas that may not be visualized on scans, and revision surgery all require the ability for systemic inspection of expected and ectopic areas of resident parathyroid tissue.

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