Primary hyperparathyroidism is due to a single adenoma in 80% to 85% of patients and to multiple enlarged parathyroid glands in 15% to 20% of patients, and management of this anatomical disparity is one crux of expertise in parathyroid surgery. Because imaging tests do not reliably diagnose or exclude multiglandular disease, 2 strategies have been shown over decades to achieve high rates of operative cure: 4-gland exploration and focused dissection with intraoperative parathyroid hormone monitoring. Additionally, minimally invasive techniques combined with intraoperative parathyroid hormone monitoring have been shown to improve quality of life, decrease morbidity, shorten operative time, and shorten hospital stay.1-6
McCoy KL, Carty SE. Intraoperative Parathyroid Hormone Criteria: The Quest for PerfectionComment on “Factors That Influence Parathyroid Hormone Half-life”. JAMA Surg. 2013;148(7):606–607. doi:https://doi.org/10.1001/jamasurg.2013.120
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