Secondary and tertiary hyperparathyroidism, state of the art surgical management

Abstract

This article reviews the current surgical management of patients with secondary and tertiary hyperparathyroidism. The focus is on innovative surgical strategies that have improved the care of these patients over the past 10 to 15 years. Modalities such as intraoperative parathyroid hormone monitoring and radioguided probe utilization are discussed.

Figures

Figure 1

Photographs of calciphylaxis showing cutaneous purpuritic lesions and ischemic necrosis on the torso (A) and medial leg (B) of a patient with secondary HPT.

Figure 2

Photographs of total parathyroidectomy and implantation of parathyroid tissue into the non-dominant forearm. Prior to surgery the non-dominant forearm should be prepped (A). After a small incision is made (B) and 50 to 100 mg of parathyroid tissue is dissected from a gland (C), the parathyroid tissue is transplanted into the brachioradialis muscle (D).