Parathyroid surgery
The spectrum of parathyroid surgery
Minimally invasive parathyroidectomy for patients with positive localisation studies.
Bilateral cervical exploration for cases with negative scans and those with familial hyperparathyroidism.
Redo parathyroidectomy for patients with failed previous parathyroid surgery.
Total parathyroidectomy for patients with secondary hyperparathyroidism due to chronic renal failure.
Who needs parathyroid surgery ?
In contrast with many other medical centres, in Oxford we always believed that all patients with a secure biochemical diagnosis of primary hyperparathyroidism should meet a surgeon to discuss the feasibility of parathyroid surgery.
Age is not a limiting criteria, severity of hypercalcaemia is not a selection criteria and negative scans are not an exclusion criteria.
In addition, all patients from known families with MEN-1 syndrome should be monitored to decide the exact timing and extent of the parathyroid operation.
I remain to be convinced about the role of surgery in all patients with normocalcaemic hyperparathyroidism as the diagnosis can be challenging and the outcome of the operation uncertain or unsatisfactory.