Importance: Primary hyperparathyroidism (pHPT) is a common clinical entity, with approximately 100 000 new cases diagnosed each year in the United States. Most patients with pHPT have a relatively mild form of the disease and present with few if any overt signs or symptoms. This has led to a dilemma regarding which patients should be considered for parathyroid surgery. In this article, we review the established literature on the indications for surgery in asymptomatic pHPT and discuss the most recent consensus conference guidelines.
Observations: The reviewed literature suggests that there were improved outcomes among patients with asymptomatic pHPT who underwent curative surgery.
Conclusions and relevance: Most patients with pHPT should be considered for parathyroidectomy. More randomized clinical trials are needed to strongly support a surgical recommendation for all asymptomatic patients with pHPT.