If the missing gland is the only tissue left it should be auto-trtansplanted into the arm. More likely after second explorations and if all glands were biopsied Pts. Should be placed on oral Calcium when feasible Magnesium Deficiency impairs secreation of PTH, always detect and replace when necessary. Gradually decrease IV CaGluconate 4. The elevation in phosphate causes increased tissue deposition.
Treatment consists of management of each of the above three measures.
Calcium carbonate, bisphosphonates, avoidance of aluminum. Most others do not benefit from surgery. Tertiary hyperplasia occurs when secondary hyperparathyroidism goes arye. Basically the hyperplasia becomes monoclonal and adenomas will form which are resistant to normal feedback and require excision in patients able to tolerate this. Some develop persistent hyperparathyroidism and do benefit from parathyroidectomy.