Patients with primary hypoparathyroidism can be accurately diagnosed. Clinical manifestations, including symptoms and metabolic conditions, improve in most patients (75%) after successful surgery. Preop-erative localization testing is helpful but not essential when a bilateral approach is performed but is essential if a unilateral or focal operation is performed. Approximately 65% of patients would qualify for a focal approach (positive localized test, sporadic disease, and no significant thyroid nodules). An approximate 95% success rate of parathyroidectomy is expected when an experienced surgeon performs the operation. Patients with familial primary hyper-parathyroidism need to be treated more aggressively than patients with sporadic disease because they are more prone to both persistent and/or recurrent disease. Most current literature suggests that patients with PHPT benefit symptomatically, metabolically, and in longevity after a successful parathyroidectomy.

Figure 5-16. Computed tomographic scan of a parathyroid adenoma in the anterior mediastinum.

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