Question:hard
What is the treatment of choice for hyperparathyroidism?
What is the treatment of choice for hyperparathyroidism?
Show Hint
In four-gland parathyroid hyperplasia, all 4 glands are removed and a small piece is autotransplanted (often to the forearm).
Updated On: Jul 8, 2026
- Removal of the hyperplastic gland
- Removal of all 4 glands
- Radical parathyroidectomy
- 3 and 1/2 parathyroidectomy
Show Solution
The Correct Option is B
Solution and Explanation
Step 1: Understanding the Concept:
Hyperparathyroidism from four-gland hyperplasia needs a different surgical plan than a simple single adenoma, since more than one gland is diseased.
Step 2: Key Formula or Approach:
The guiding rule in parathyroid hyperplasia is to remove all diseased tissue from the neck to prevent the disease persisting or coming back, while still leaving the patient with enough parathyroid hormone to avoid permanent low calcium.
Step 3: Detailed Explanation:
If a surgeon takes out only one enlarged gland, the other three keep secreting excess hormone, so the calcium stays high and the operation fails. Taking out all four hyperplastic glands and grafting a small piece into an easily accessible site like the forearm solves both problems: the neck is cleared of disease, and the graft still makes enough hormone for the body's needs. If the graft itself becomes overactive later, it is far easier and safer to trim tissue from the forearm than to reopen a scarred neck. This is why total removal of all four glands, paired with autotransplantation, is generally favored over leaving a small remnant of gland behind in the neck (the three and a half gland approach), which risks a harder second neck surgery if the disease recurs. Removing just one enlarged gland, or a vaguely named radical parathyroidectomy, does not properly address multi-gland disease.
Step 4: Final Answer:
The treatment of choice in parathyroid hyperplasia is removal of all four glands with reimplantation of a small fragment.
\[ \boxed{\text{Removal of all 4 glands}} \]
Hyperparathyroidism from four-gland hyperplasia needs a different surgical plan than a simple single adenoma, since more than one gland is diseased.
Step 2: Key Formula or Approach:
The guiding rule in parathyroid hyperplasia is to remove all diseased tissue from the neck to prevent the disease persisting or coming back, while still leaving the patient with enough parathyroid hormone to avoid permanent low calcium.
Step 3: Detailed Explanation:
If a surgeon takes out only one enlarged gland, the other three keep secreting excess hormone, so the calcium stays high and the operation fails. Taking out all four hyperplastic glands and grafting a small piece into an easily accessible site like the forearm solves both problems: the neck is cleared of disease, and the graft still makes enough hormone for the body's needs. If the graft itself becomes overactive later, it is far easier and safer to trim tissue from the forearm than to reopen a scarred neck. This is why total removal of all four glands, paired with autotransplantation, is generally favored over leaving a small remnant of gland behind in the neck (the three and a half gland approach), which risks a harder second neck surgery if the disease recurs. Removing just one enlarged gland, or a vaguely named radical parathyroidectomy, does not properly address multi-gland disease.
Step 4: Final Answer:
The treatment of choice in parathyroid hyperplasia is removal of all four glands with reimplantation of a small fragment.
\[ \boxed{\text{Removal of all 4 glands}} \]
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