Parathyroid adenoma is a surgically correctable condition. The evidence-based protocol applies to patients who appear, on clinical and imaging assessment, to have a single parathyroid adenoma and are candidates for a focused operative approach.
The protocol targets reestablishment of normal calcium homeostasis (eucalcemia) lasting a minimum of 6 months, and normalization of parathyroid hormone levels assessed at 6 months post-procedure.
DOI: 10.1001/jamasurg.2016.2310
Parathyroidectomy is the only definitive treatment of pHPT.
Defined as a focused dissection, MIP is ideally used in patients who appear clinically and by imaging to have a single parathyroid adenoma.
When image-guided focused parathyroidectomy is planned, IPM is suggested to avoid higher operative failure rates.
Minimally invasive parathyroidectomy can achieve cure in 97% to 99% of selected patients when adjunctive IPM is used to confirm adequacy of resection.
Cure after parathyroidectomy is defined as the reestablishment of normal calcium homeostasis lasting a minimum of 6 months.
Although there is no role for routine PTH measurement in the normocalcemic patient in the immediate postoperative period, failure to normalize PTH levels at 6 months or longer can signify early operative failure.
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