When preoperative parathyroid imaging is discordant or fails to localize the lesion, or when clinical features raise a high suspicion of multigland disease (MGD), a standard focused, image-guided approach is not routinely recommended. This scenario calls for a distinct operative strategy.
This protocol addresses parathyroid adenoma in the setting of high suspicion of multigland disease, or when preoperative parathyroid imaging is discordant or nonlocalizing. A focused, minimally directed approach is not routinely recommended in these patients.
The preferred operative strategy involves a planned bilateral exploration, systematically identifying all parathyroid glands in expected and, where necessary, ectopic cervical locations. The complete intraoperative algorithm, decision criteria, and sequencing are detailed in the full protocol.
Full operative regimen and decision points available via the link below.
The aim is reestablishment of normal calcium homeostasis (eucalcemia) lasting a minimum of 6 months, along with normalization of parathyroid hormone levels at 6 months.
DOI: 10.1001/jamasurg.2016.2310
It is not routinely recommended in patients with known or suspected high risk of MGD.
Planned BE is the preferred operative strategy in situations of discordant or nonlocalizing preoperative imaging, when there is a high suspicion of MGD, when IPM is not available, or at the discretion of the surgeon.
Bilateral exploration provides a time-tested standard of efficacy and safety in the definitive treatment of pHPT.
Cure after parathyroidectomy is defined as the reestablishment of normal calcium homeostasis lasting a minimum of 6 months.
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