Focused parathyroidectomy, by a high-volume endocrine surgeon.

Prices vary by unit, by the named surgeon, by whether IOPTH is included, and by any combined thyroid surgery. Combined total thyroidectomy is quoted separately. We come back with a firm quote within one working day.

• Symptomatic primary hyperparathyroidism

  Nephrolithiasis, osteoporosis, hypercalcaemic crisis, neuromuscular fibromyalgia-like symptoms or cognitive fog with a raised PTH and calcium.

• Asymptomatic, but Bilezikian 2022 criteria met

  Age under 50, calcium more than 0.25 mmol/L above upper limit, GFR under 60, T-score at or below -2.5 at spine, hip or wrist, or a vertebral fracture.

• Single adenoma on concordant imaging

  Ultrasound and MIBI SPECT-CT both pointing to the same gland is the ideal setup for a focused approach with IOPTH.

• MIBI-negative but 4D-CT positive

  Around 10 to 20% of adenomas are MIBI-negative. 4D-CT or 18F-choline PET-CT often finds them and still allows a focused operation.

• Recurrent or persistent hyperparathyroidism

  A re-do neck with prior scarring needs the most experienced hands, careful re-imaging, and a lower threshold for bilateral exploration.

• Discordant or negative localisation

  When ultrasound and MIBI disagree, or both are negative, a focused approach is unsafe. Bilateral neck exploration is the honest recommendation.

• Suspected multi-gland disease

  Familial hyperparathyroidism, MEN1, MEN2A or lithium-related disease. Multi-gland disease is not a focused-MIP indication.

• Red flag: hypercalcaemic crisis

  Calcium above 3.5 mmol/L with dehydration, confusion or arrhythmia is an emergency. Rehydration and inpatient work-up first, not an outpatient booking.

• General anaesthesia, day-case or one night

  A short GA with a short-acting muscle relaxant. Most patients go home the same day; some stay one night for calcium monitoring, particularly with prior severe hypercalcaemia.

• Transient hypocalcaemia

  A tingling in fingers and around the mouth in the first 24 to 72 hours is common (5 to 15%). Short-course oral calcium and calcitriol settle it quickly.

• Hungry-bone syndrome

  After long-standing severe disease, bones rapidly re-mineralise and pull calcium out of the blood. Managed with higher-dose calcium and calcitriol for a few weeks.

• Recurrent laryngeal nerve injury

  Temporary hoarseness in 1 to 3%; permanent injury in under 1% in high-volume hands with nerve monitoring. Discussed and consented before surgery.

• Persistent hyperparathyroidism

  Calcium and PTH still raised after surgery, usually from a missed second adenoma or ectopic gland. Uncommon (2 to 5%) with concordant imaging and IOPTH.

• Recurrent hyperparathyroidism

  Disease returning more than 6 months after a biochemical cure. Rare with true single-adenoma disease; more common in familial or multi-gland syndromes.

• Scar and cosmesis

  A small horizontal anterior neck scar, usually 2 to 3 cm, sitting in a natural skin crease. Fades over 6 to 12 months. Silicone tape can be used from week two.

• Return to normal activity

  Desk work at 3 to 5 days. Driving once off strong analgesia. Full exercise at 2 weeks. Avoid heavy lifting for 10 days to protect the closure.

• Red flags after discharge

  Sudden neck swelling, difficulty breathing, severe tingling with muscle cramps, spasm at the wrist or a voice that will not come back after 48 hours. Call the unit or go to A&E.