This protocol covers primary hyperparathyroidism (PHPT) in patients with single-gland disease — specifically a single adenoma — where parathyroid localisation imaging is concordant. Multi-gland disease is absent and no genetic or familial risk factors for multi-gland involvement are present.
The majority of PHPT patients have single-gland disease. A focused surgical approach is appropriate after discussion with the patient regarding the possibility of persistent disease.
In this setting, a minimally invasive, targeted surgical approach to the parathyroid is the indicated intervention. The complete operative protocol — including intraoperative management of the parathyroid tissue — is specified in the full regimen.
The primary outcome target is eucalcaemia — normal serum calcium — confirmed at 6 months after surgery, which defines surgical cure.
DOI: 10.1111/cen.14650
Minimally invasive parathyroidectomy is appropriate in most patients with concordant imaging.
The majority of PHPT patients have single gland disease and a focussed approach is appropriate following discussion with the patient regarding the possibility of persistent disease.
When a normal parathyroid gland is de-vascularised in parathyroidectomy for sporadic disease, it should be auto-transplanted.
Serum calcium should be measured 6 months after parathyroidectomy.
Cure is defined as eucalcaemia 6 months after parathyroidectomy.
Eucalcaemia at 6 months is consistent with surgical cure; parathyroid hormone levels do not need to be re-checked in the absence of other clinical indications.
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