Parathyroidectomy

Procedure Snapshot

• Indication: Primary hyperparathyroidism (symptomatic or Ca > 1 mg/dL above ULN).
• Expected duration: ___
• Special instruments: Nerve monitor, gamma probe, 10× loupe.

Step Workflow

1. Transverse collar incision; develop subplatysmal flaps.
2. Identify thyroid lobes and recurrent laryngeal nerve.
3. Locate enlarged parathyroid gland (pre-op localization helps).
4. Excise and send frozen section.
5. Check intra-op PTH drop > 50 % → success.

Key Pimp Questions

• Q: Most common location? A: Inferior posterior to thyroid (lower pole).
• Q: Hungry bone syndrome? A: Rapid Ca drop post-op (PMID 31051264).

Critical Anatomy

• Landmarks: Thyroid capsule, RLN, inferior thyroid artery.
• Danger zones: RLN injury.

Informed Consent Highlights

• Hypocalcemia __, voice change __, bleeding ___.

Post-op Considerations

• Monitor Ca/PTH; replace Ca and Vit D as needed.

References

• Chassin’s, Endocrine. Clinical Scenarios, Endocrine.
• Bergenfelz 2019 (PMID 31051264).