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  • Hyperparathyroidism
  • Parathyroid cancer
  • Patients whose condition is unstable
  • Secondary HPT responsive to renal transplantation

Parathyroid tray

  • There are usually four parathyroid glands, which lie on the posterior surface of the thyroid.
    • The superior glands are normally located on the posteromedial aspect of the thyroid near the tracheoesophageal groove.
    • The inferior parathyroids are more widely distributed in the region below the inferior thyroid artery.
  • Both the superior and inferior parathyroid glands receive their blood supply from the inferior thyroid artery in 80% of cases.

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  • Calcium assay performed within 24 hours of surgery
    • If no signs of hypocalcemia are present, no calcium supplementation may be necessary.
    • If symptoms occur or if the surgeon is concerned about the patient's parathyroid status, daily supplements of 1500 to 3000 mg of elemental calcium may be started.
  • There is good evidence that clinical outcomes are related to the experience of the surgeon performing the parathyroidectomy, such that high-volume endocrine surgeons have higher cure rates and lower complication rates.
  • Reported rates of nerve injury range from 1% to 10%.
    • Superior laryngeal nerve injury results in subtle voice changes, which can have profound deleterious effects in professional singers or speakers.
  • Hematoma and wound infection are uncommon.
  • Hypoparathyroidism from injury to or removal/devascularization of the remaining parathyroids can occur and result in hypocalcemia. Transient postoperative hypocalcemia is not uncommon.
  • Before surgery, patients with primary HPT also showed greater delays in spatial learning. All subjects learned across the neurocognitive trials, but patients with primary HPT were more delayed.
  • After surgery, patients with primary HPT improved and functioned at a level equivalent to that of patients with thyroid disease.
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