Fifty-three reoperations for hyperparathyroidism.

Fifty-three patients, 35 with persistent and 7 with recurrent hyperparathyroidism, had parathyroid surgery. There were 11 patients who had prior thyroid surgery before being identified as having hyperparathyroidism. Forty patients had parathyroid adenomas and 13 (8 dialysis patients) had parathyroid hyperplasia. Thallium-210-iodine 123 subtraction scanning proved to be the most accurate in localizing parathyroid adenomas (60 percent) but not parathyroid hyperplasia. Resection of 3 3/4 parathyroid glands in primary parathyroid hyperplasia and total parathyroidectomy with parathyroid autotransplantation in tertiary parathyroid hyperplasia are the treatments of choice and would have prevented reoperation in this group. Careful neck exploration, resection of the thymus, and even thyroidectomy would probably have led to the correct location of the missed parathyroid adenomas. Mediastinotomy should not be performed at initial surgery. A careful history and preoperative calcium and phosphorus determinations in all thyroid surgery patients will reveal occult hyperparathyroidism. Twenty-one such patients were identified in our overall parathyroid series.