Evaluation and Decisions During Parathyroid Surgery

Abstract

The panelists were first asked what they would do if they encountered a single enlarged gland and three normal glands at surgery. The group agreed that they would remove the enlarged gland, and either biopsy one of the remaining normal ones, or remove it. One panelist suggested that he would not explore the contralateral side if he found a normal gland and an adenoma on the initially explored side. When pressed in the question period, he pointed out that he did not fail to explore the other side unless everything was clear cut, including demonstration of pathologic parathyroid tissue by flotation and completely normal parathyroid tissue in the normal gland, with histologic confirmation of both adenoma and normal tissue. Because of the possible presence of a fifth parathyroid gland, and on occasion an adenoma in that gland, the panel felt that the thymus on each side should be carefully palpated.