Results of surgical and medical treatment in primary hyperparathyroidism.

The success rate of surgical treatment in large series of p-HPT is about 95%. The usual reasons for failure are insufficient exploration of the neck and unrecognized multiple gland involvement. Such failures might be avoidable. Persistent HPT after an adequate neck dissection may be due to a diseased gland in the anterior mediastinum or within the parenchyma of the thyroid. There are also a few cases with true recurrent disease. If a reoperation is required localization studies can be helpful. The success rate in the present reoperative series was 94% showing that most patients with p-HPT can be cured by surgery. The rate of hypoparathyroidism after reoperative surgery can be minimized by autotransplantation of diseased parathyroid tissue. There are no current medical substitutes for the surgical management of p-HPT.