Vit-D causes phosphate to be absorbed better. Be careful with this because renal failure decreases phosphate excretion. The committee also concluded that PTH assay is now sensitive, specific and reliable enough to usually make other tests unnecessary. These patients need to be monitored semi-annually with iPTH, Creatinine levels, 24hour urinary Ca, creatinine clearance, bone density and abdominal radiography. Surgery is the rule for all others who are able to tolerate.
Success rate is high, morbidity is low, cure is common.
Neck exploration should have excellent hemostasis. Neck incision is the same as for thyroidectomy. Skin flaps should be elevatd extensively up to the thyroid cartilage notch and inferiorly to the clavicles and suprasternal notch. Open the investing fascia and ligate the middle thyroid vein. Grasp the thyroid with a babcock and retract it medially.