Question

What is the treatment of choice for hyperparathyroidism?

• A. Removal of the hyperplastic gland
• B. Removal of all 4 glands
• C. Radical parathyroidectomy
• D. 3 and 1/2 parathyroidectomy

Hint:

In four-gland parathyroid hyperplasia, all 4 glands are removed and a small piece is autotransplanted (often to the forearm).

Answer 1

The Correct Option is B

Step 1: Split the causes of hyperparathyroidism.
Primary hyperparathyroidism is caused by an overactive parathyroid gland or glands. About 85% of cases come from a single adenoma in one gland, but a meaningful minority come from hyperplasia, where all four glands are enlarged and overactive together, as seen in some familial syndromes and in secondary or tertiary hyperparathyroidism from long-standing kidney disease.

Step 2: Focus on the four-gland hyperplasia scenario.
When all four glands are diseased, removing just one gland leaves three overactive glands behind, so the disease keeps going. The surgery has to deal with all four glands, not just one.

Step 3: Explain what removal of all 4 glands means in practice.
The standard operation for four-gland hyperplasia is a total parathyroidectomy, where all four enlarged glands are taken out of the neck, and then a small piece of parathyroid tissue is immediately reimplanted, usually into a forearm muscle. This autotransplant keeps a source of parathyroid hormone that can be adjusted or removed later if needed, while clearing the neck completely of diseased tissue.

Step 4: Compare with the other options.
Removing only the hyperplastic gland would miss the other enlarged glands and fail to cure the patient when hyperplasia is bilateral and multi-gland. Radical parathyroidectomy is not a standard recognized operation name for this condition. A subtotal, three and a half gland parathyroidectomy (leaving a remnant in the neck) is an alternative approach some surgeons use, but it carries a higher chance the disease recurs in the remaining neck tissue, and reoperating in a scarred neck is riskier than trimming a small forearm graft if hyperplasia comes back after a full four-gland clearance with autotransplant.

Step 5: Final conclusion.
For parathyroid hyperplasia, the preferred approach is to clear the neck completely.
\[ \boxed{\text{Removal of all 4 glands (with autotransplantation)}} \]