CAUSE AND CURRENT MANAGEMENT OF REOPERATIVE HYPERPARATHYROIDISM

We reviewed 137 cases of hyperparathyroidism followed for 6-72 months to determine the reasons for failure and to outline the successful man agement of reoperative hyperparathyroidism. Of 127 patients treated in itially at Thomas Jefferson University Hospital, three required reoper ation (2.4%) and 10 were referred with recurrent or persistent hyperpa rathyroidism. Reasons for failure were a missed gland in eight cases ( 62%), an ectopic gland in two cases (15%), supernumerary glands in two cases (15%), and malignant degeneration of an autotransplant in one c ase (8%). One patient had short-term hypoparathyroidism requiring vita min D supplementation (5.6%), but there were no injuries to the recurr ent laryngeal nerves. We conclude that adequate knowledge of the locat ion of normal and ectopic glands with meticulous search will reduce mo st reoperations, and, with identification of all four glands and routi ne cervical thymectomy in multigland disease, the rate should be less than 5 per cent. Patients requiring reoperation should undergo noninva sive localization studies and, if equivocal, selective venous sampling for parathyroid hormone. The major complication rate should be less t han 10 per cent.