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RECOMMENDATION: Multigland disease affects approximately 15% of pHPT patients and should be routinely considered in preoperative planning.


COMMENT: Most patients with pHPT have a single benign tumour (parathyroid adenoma) which can be removed with a straightforward minimally invasive keyhole procedure, either as a day only or overnight procedure. However surgery for pHPT is not always straightforward as up to 15%  of patients of are complex with more than one parathyroid gland involved. The possibility of multiple gland disease (MGD) needs to be explored and explained prior to any operation as it may require a more complex open four gland bilateral neck exploration (BNE).


RECOMMENDATION: Exposure-related and genotype-phenotype correlations are predictive of parathyroid anatomy and pathology, and should be considered as they may impact the planning and conduct of surgery.


COMMENT: Previous ionising radiation exposure of familial pHPT can also require a more complex operation due to MGD

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