Maximizing outcomes while minimizing exploration in hyperparathyroidism using localization tests

Hypothesis: Preoperative localization (ultrasonography and scintigraphy) can be used to limit operative exploration in primary hyperparathyroidism while providing a high rate of success. Design: Prospective cohort analysis of 3 types of exploration (1-gland, unilateral, or 4-gland), as directed by localization. Results: In 185 consecutive patients who underwent operations, the final diagnoses were solitary adenoma in 87% and multigland disease in 13%. Ultrasonography (75%) and scintigraphy (83%) demonstrated an enlarged parathyroid gland and, together with operative findings, resulted in 61 1-gland, 63 unilateral, and 61 4-gland explorations, with an initial success rate of 96% and an ultimate success rate of 99%. Limiting exploration resulted in a significant decrease in operative time and hospitalization. Conclusion: Localization can limit exploration with success.