Parathyroidectomy is the only curative treatment for patients with primary hyperparathyroidism. Although care must be individualized, parathyroidectomy should be considered in all patients with biochemically confirmed primary hyperparathyroidism, irrespective of symptoms. Subtotal parathyroidectomy or total parathyroidectomy with transplant is indicated in secondary hyperparathyroidism with renal osteodystrophy, calciphylaxis, or when medical therapy fails or cannot be tolerated. Parathyroid surgery can achieve superb cure rates with minimal morbidity when performed by experienced surgeons. The best surgical approach to parathyroidectomy incorporates strategic exploration guided by anatomic relationships in a bloodless field. Although bilateral neck exploration is an acceptable approach for parathyroid adenomas, minimally invasive parathyroidectomy with intraoperative hormone monitoring can achieve similar cure rates.
