Objectives and Methods
We retrospectively analyzed 58 cases of primary hyperparathyroidism that were managed surgically in our department over the course of 7 years from 2014 to 2021. 

Results
The mean age of patients undergoing surgery was 55.9 years, ranging from 22 to 80 years. A combination of ultrasonography and scintigraphy was used to image the lesions preoperatively. The former successfully localized the lesion in 47/58 cases, revealing eight, 14, 11, and nine right superior, right inferior, left superior, and left inferior lesions, respectively. The latter successfully localized the lesion in 53/58 cases. Between both imaging modalities, localization of the lesion failed in only a single case. Intraoperatively, the recurrent nerve was absent from the operative field in 18 cases, 12 of which exhibited inferior circulation lesions. Postoperatively, two patients presented with transient postoperative recurrent laryngeal nerve palsy; in both cases, the nerve had been identified and preserved intraoperatively. There were no cases of permanent paralysis. Histopathological analysis of surgical specimens revealed 49 cases of adenoma; four of hyperplasia; three of normal parathyroid gland; three of unidentified normal thyroid tissue; and one of cancer. There was no correlation between preoperative maximum diameter of the parathyroid gland and plasma concentration of intact parathyroid hormone (PTH). However, the average plasma calcium and intact PTH concentrations both significantly decreased from 11.2 mg/dL preoperatively to 9.3 mg/dL postoperatively and 213.3 pg/mL preoperatively to 40.6 pg/mL postoperatively, respectively. In five cases, intact PTH decreased but did not normalize. The mean preoperative bone mineral density T-score was -2.1, but no significant improvement was observed at long-term follow-up.

Conclusions

Parathyroidectomy is a safe and effective procedure. Nonetheless, despite improvements in local diagnostic techniques, some cases cannot be managed with a single adenectomy. As such, it is important to consider the necessity of a bilateral search.