ABSTRACT
Persistent hyperparathyroidism (HPT) is defined as the development of hypercalcaemia within 6 months of the first parathyroid operation, whereas hypercalcaemia presenting after an interval of 6 months is termed recurrent HPT. In two landmark publications investigating the reasons for failed parathyroidectomy from California and Uppsala, Sweden, the percentage of distribution between persistent and recurrent disease is remarkably similar. Most reoperative surgery is for persistent disease. Reoperation should only be considered if the patient has symptomatic hypercalcaemia or when there is evidence of progressive disease. Parathyroid localization is an essential step in reoperative surgery. The surgical strategy is influenced by the clues from previous surgery and the outcome of the localization studies. A positional statement by the European Society of Endocrine Surgeons on modern techniques in parathyroid surgery did not recommend the routine use of neuromonitoring in first-time neck exploration but stated that it may be of value in reoperative surgery.
