Parathyroidectomy is the only definitive treatment for primary hyperparathyroidism. Most patients with primary hyperparathyroidism have a single parathyroid adenoma, though a significant minority (up to 10%) may have double adenomas, and a small minority will have hyperplasia of all 4 glands.[1]

parathyroid adenoma. Bilateral neck exploration: In cases of unsuccessful preoperative localisation the surgeon explores the necks fully, identifies all four parathyroid glands and removes the adenoma. Subtotal parathyroidectomy: This is indicated with parathyroid hyperplasia when all the glands have the capacity for

Radiographic parathyroidectomy can be considered as a type of focused parathyroidectomy. The patient receives a small injection of Tc-99m sestamibi the morning of the surgery. A handheld gamma probe is employed in the operating theater by the surgeon to detect the hyperactive gland.

An expert knowledge of the unusual anatomic locations for enlarged parathyroid glands is crucial to operative success during both initial and reoperative parathyroid surgical exploration. The wide range of parathyroid anatomic variations may make it difficult to predict a patient's anatomy preoperatively.

RELEVANT ANATOMY. A detailed knowledge of the embryology of parathyroid glands is helpful when only 3 normal glands have been found and the pathologic gland has not been located. The development of the parathyroid glands and thymus gland is specifically related to the embryology of the third and fourth branchial arches.