Surgery of the parathyroids

1. Big picture

Parathyroid surgery is mainly surgery for hyperparathyroidism, especially primary hyperparathyroidism caused by a parathyroid adenoma. The examiner wants you to understand the full logic:

High calcium
        ↓
Measure parathyroid hormone — PTH
        ↓
PTH high or inappropriately normal?
        ↓
Primary / secondary / tertiary hyperparathyroidism
        ↓
Decide if surgery is indicated
        ↓
Localize abnormal gland if primary disease
        ↓
Perform focused or bilateral neck exploration
        ↓
Confirm cure by intraoperative PTH fall
        ↓
Monitor postoperative calcium

The key surgical danger after parathyroidectomy is hypocalcemia