The best localization is an experienced parathyroid surgeon

Prior to recent advancements in parathyroid imaging and the development of intraoperative parathyroid hormone (ioPTH) monitoring, bilateral exploration (BE) of all four parathyroid glands was the gold standard for the intraoperative management of primary hyperparathyroidism (pHPT). Modern imaging modalities, such as 99-Tc Sestamibi (with or without SPECT), high-resolution cervical ultrasonography, and 4D-CT, provides surgeons with detailed information for preoperative planning. Although there is no consensus on which imaging modality should be obtained prior to parathyroidectomy, a localizing (‘positive’) study allows for a planned minimally invasive parathyroidectomy (MIP) with ioPTH monitoring.

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