Goals of surgical treatment of patients with secondary hpt is balancing between extent of parathyroid resection with avoidance of persistent disease and postoperative hypoparathyroidism. There are several well-established surgical procedures for managing those patients. At our clinic most common procedure is subtotal parathyroidectomy with bilateral neck exploration with or without cervical thymectomy.

From January 2008 until November 2023. 189 patients were operated for sHPT. We excluded the patients with missing data (lack of postoperative level of PTH, calcemia, phosphatemia etc.). The mean preoperative pth level was 1832 ng/L (ranging 15-65 ng/L) and calcemia was 2.56 mg/L (2,15-2,65 mg/L).

After surgery mean postoperative pth level was 178,5 ng/L ranging from 3 ng/L to 2000 ng/L, while mean serum calcium level was 2,23 mmol/L. Fourteen patients were operated for persistent sHPT (17%), while 2 patients (2,46%) have postoperative hypoparathyroidism. In eight out of fourteen patients who were reoperated due to persistent hyperparathyroidism pth level dropped after cervical thymectomy was performed. We analyzed the data that were published with usage of intraoperative pth level and found that in some cases iopth predicted biochemical resolution of hyperparathyroidism but it failed to predict persistent hypoparathyroidism or it did not alter surgical management in patients.

Intraoperative PTH can be useful in patients ongoing surgery for sHPT but it does not necessarily leads to better outcomes. The best results can be expected not only with ioPTH but also with good preoperative localization and the crucial moment is usually experience of surgeon (team) who perform the surgery.