This protocol addresses patients who have undergone parathyroid surgery (parathyroidectomy) and subsequently present with elevated serum corrected calcium. The presentation falls into one of two distinct patterns:
Persistent PHPT — elevated serum corrected calcium within 6 months of the initial parathyroid surgery, indicating that biochemical cure was not achieved.
Recurrent PHPT — elevated serum corrected calcium that develops after more than 6 months of consistently normal serum corrected calcium following parathyroidectomy.
The primary objective of management in this post-surgical setting is biochemical cure — restoration of normal serum calcium — while minimising procedural risk given the altered surgical anatomy.
Management follows a structured, stepwise assessment before any intervention. When re-intervention is indicated, the approach centres on image-guided, focused re-operative parathyroidectomy. For persistent disease, reoperation is generally deferred to allow adequate tissue recovery before proceeding.
The full stepwise algorithm, assessment sequence, and procedural planning details are available in the complete protocol.
DOI: 10.1111/cen.14650
Persistent PHPT is defined as elevated serum corrected calcium within 6 months of parathyroid surgery.
Recurrent PHPT is defined as elevated serum corrected calcium that develops after more than 6 months of consistently normal serum corrected calcium post-parathyroidectomy.
A stepwise approach to the assessment and management of persistent or recurrent PHPT is needed.
In general, an image-guided focused reoperation is recommended.
Reoperation for persistent PHPT should be delayed at least 3-6 months to allow acute inflammatory changes to settle, even though scarring tends to persist long term in the neck.
The goal of a re-operative parathyroidectomy is biochemical cure while minimising risk.
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