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February 1988

Primary Hyperparathyroidism: Changing Principles in Evaluation and Surgical Approach

Author Affiliations

Stanford, Calif.

Arch Otolaryngol Head Neck Surg. 1988;114(2):121. doi:10.1001/archotol.1988.01860140019005

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Ashok Shaha, MD, and collaborators, New York, reported their five-year experience with 61 patients who underwent neck exploration for primary hyperparathyroidism. Their presentation was at the 91st annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery, Chicago. The diagnosis was made on the basis of serum calcium, phosphorus, and parathormone levels, and a 24-hour urinary calcium evaluation. Preoperatively, localization studies were obtained in only ten patients. These studies included ultrasound, thalliumtechnetium subtraction scans, and computed tomographic scan of the neck and mediastinum. More invasive studies, such as arteriography, selective venous catheterization, and digital subtraction angiography, were used only in those patients who underwent secondary explorations. Bilateral neck exploration was performed, and identification of all four parathyroid glands was undertaken. Multiglandular disease occurred in 13% of patients. Frozen section was utilized to distinguish parathyroid gland from thymus, fat, thyroid, or lymph node. Hypoparathyroidism developed in two patients (one permanent)

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