Occasionally, if the causes of secondary hyperparathyroidism persist for some time, one parathyroid gland may become autonomous.The cells start producing excessive amounts of PTH even if the stimulus of low calcium is removed (e.g. after medical treatment).This is known as tertiary hyperparathyroidism.In these very rare circumstances parathyroid surgery is necessary to correct the autonomous parathyroid abnormality.
The exact type of operation performed depends on each individual situation. The two main operations performed in this case are:
Which operation is performed depends on the exact state of the parathyroid glands as seen at operation, the expertise of the surgeon and the "protocol" agreed at the hospital.