ABSTRACT
While parathyroid disease in children is rare, timely diagnosis and treatment are paramount for optimal childhood development. When preoperative imaging localizes an abnormal gland in a child with primary hyperparathyroidism, minimally invasive parathyroidectomy (MIP) can be considered. Compared to bilateral four-gland exploration, MIP involves a focused unilateral exploration. Radio-guided parathyroidectomy involves intravenous injection of technetium-99m sestamibi 1–2 hours preoperatively and then use of a gamma probe intraoperatively to help localize hyperfunctioning parathyroid glands. Patients are deemed “cured” after parathyroidectomy if they are able to maintain normal calcium levels over the long term. Pediatric patients experience cure rates of 96–100% after parathyroidectomy for hyperparathyroidism, rates similar to the adult population. In children with chronic kidney disease, total parathyroidectomy with auto-transplantation provides excellent long-term control of hyperparathyroidism and calcium-phosphate metabolism, and may thus mitigate cardiovascular-related disease and uremic bone disease.
