Revision parathyroid surgery

Hyperparathyroidism is an uncommon disease, that is, usually diagnosed after a patient is found to have repeatedly elevated calcium levels on routine blood testing. Some patients may experience problems with recurrent kidney stones, memory difficulty, constipation, osteoporosis, or chronic fatigue. Patients exhibit chronic calcium and parathyroid hormone elevation, often undiagnosed for several years. Surgery is the definitive intervention, resulting in cure in 95% of patients when performed by an experienced parathyroid surgeon. Unfortunately, many patients initially receive surgical exploration by surgeons with limited experience, resulting in biochemical cure rates as low as 60%-70%. Unfortunately, recurrence may occur due to failed exploration, a second adenoma, or multigland hyperplasia. Resolution of the hyperparathyroid state requires additional surgery to remove any overactive parathyroid tissue. Reoperative surgery inherently brings increased surgical risks and decreased surgical success of cure. Hence, a focused and organized approach to this patient population is essential for optimizing the outcome of revision parathyroid surgery.