Treatment of Primary Hyperparathyroidism with Negative or Discordant Parathyroid Localisation Imaging

When preoperative parathyroid imaging is inconclusive or points in conflicting directions — or when the clinical picture suggests disease beyond a single gland — standard focused surgical approaches may not be appropriate. Specific patient characteristics call for a distinct, evidence-based strategy.

Clinical Scenario

Negative or discordant parathyroid localisation imaging
Known bilateral or multi-gland parathyroid disease
Genetic or familial risk factors for multi-gland disease
Use of a provocative medication (e.g., lithium)

Approach & Clinical Target

In these situations, the evidence-based surgical approach involves bilateral neck exploration — the complete protocol specifies the full decision framework and procedural criteria.

The clinical target is eucalcaemia (normal serum calcium) confirmed at 6 months following parathyroid surgery, which defines surgical cure.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/cen.14650

Bilateral neck exploration should be considered in those with discordant/negative imaging findings, multi-gland disease and genetic/familial risk factors.

BNE should be preferentially considered in any patient with negative/discordant localisation imaging, known bilateral/multi-gland disease, known genetic/familial risk factors for multi-gland disease or those on provocative medications (e.g., lithium).

Serum calcium should be measured 6 months after parathyroidectomy.

Cure is defined as eucalcaemia 6 months after parathyroidectomy.

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