Parathyroid Surgery

A 48-year-old man from Mumbai with a 3-year history of primary hyperparathyroidism (serum calcium 11.2 mg/dL, PTH 156 pg/mL) undergoes bilateral neck exploration after a negative serum intraoperative PTH drop. Intraoperative findings reveal a 0.8 cm left inferior parathyroid adenoma and a 1.2 cm right inferior parathyroid gland with hyperplastic appearance. The left adenoma is removed, but the right gland remains enlarged. What is the most appropriate intraoperative management of the right inferior parathyroid gland?

Which of the following is the embryological origin of the inferior parathyroid glands?

A 52-year-old woman from Delhi presents with a 6-month history of polyuria, polydipsia, and recurrent nephrolithiasis. On examination, she is alert but complains of generalized weakness. Laboratory investigations reveal serum calcium 11.8 mg/dL (normal 8.5–10.5), serum phosphate 2.1 mg/dL (normal 2.5–4.5), alkaline phosphatase 92 IU/L, and intact PTH 187 pg/mL (normal 15–65). Serum creatinine is 1.2 mg/dL. Imaging shows a 1.2 cm nodule in the left inferior parathyroid gland with no other parathyroid enlargement on ultrasound. Intraoperative PTH monitoring is planned. What is the expected intraoperative PTH level at which surgery can be terminated after successful removal of the adenoma?

In primary hyperparathyroidism, which of the following histological findings is most consistent with a parathyroid adenoma?

A 48-year-old man from Mumbai undergoes successful right inferior parathyroidectomy for a 1.5 cm parathyroid adenoma under general anesthesia. Intraoperative PTH monitoring showed an appropriate drop from 165 pg/mL to 42 pg/mL. On postoperative day 1, he develops perioral paresthesias and positive Chvostek's sign. Serum calcium is 7.2 mg/dL (normal 8.5–10.5), phosphate 4.8 mg/dL (normal 2.5–4.5), magnesium 1.6 mg/dL (normal 1.7–2.2), and PTH 8 pg/mL (normal 10–65). What is the most likely cause of his symptoms?