Long-Term Success of Surgery for Primary Hyperparathyroidism: Focused Exploration using Intraoperative Parathyroid Hormone Monitoring Versus Four-Gland Exploration

  • Wesley Barnes
  • Peter F. Czako
  • Sapna NagarEmail author
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Primary hyperparathyroidism is a common problem that is a result of the excessive secretion of parathyroid hormone (PTH) from the parathyroid glands. This is most commonly caused by a single hypersecreting adenomatous gland. Most all patients with primary hyperparathyroidism meet criteria for surgery. The best operation should provide the highest rate of cure with the lowest rate of complications. The standard surgical approach has traditionally been a four-gland exploration. Though this method has endured many years of excellent cure rates, it has been challenged because a long-lasting cure is possible with the removal of a single adenoma in the majority of cases. Thus, a focused exploration via an image-guided, open unilateral exploration employing intraoperative PTH (ioPTH) monitoring has gained popularity over the last two decades. Specifically, ioPTH monitoring has been shown to be paramount to this approach, enabling a more limited exploration by accurately guiding gland excision and predicting postoperative cure. Several large series of focused parathyroid operations have shown excellent, durable cure rates similar to standard four-gland exploration. Focused exploration guided by ioPTH is a safe, effective technique that is recommended for most patients with sporadic primary hyperparathyroidism.


Primary hyperparathyroidism Hypercalcemia Four-gland exploration Bilateral neck exploration Focused parathyroidectomy Minimally invasive parathyroidectomy(MIP) Limited parathyroidectomy Intraoperative parathyroid hormone monitoring (IOPTH) 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryOakland University William Beaumont School of Medicine, Beaumont HospitalsRoyal OakUSA

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