I would also add external beam therapy to the operative field. I realize this a very aggressive but the results once the disease has recurred are very poor. When in a patient with severe hypercalcaemia a hard mass is found, the mass itself and the ipsilateral thyroid and local lymph nodes should all be excised on-bloc, if necessary sacrificing the recurrent laryngeal nerve. Postoperative external beam radiotherapy should be used, even though there is thought to be complete clearance of the tumour. Chemotherapy is of little value.
Most deaths are due to uncontrollable hypercalcaemia resistant to bisphosphonates.
A Solitary parathyroid micro adenoma is very rare, is found in previously explored cases and is a minute highly active tumour within a normal sized parathyroid gland. Excision is curative. I have never seen a case in 25 years of endocrine surgical practice. These nodules are minute pieces of parathyroid that have broken off the parathyroid tumour and grown. They must be completely excised with the surrounding thyroid tissue.