Advanced Surgical Management of Hyperparathyroidism: Total Parathyroidectomy with Supraomohyoid Neck Dissection. Case Report

Hyperparathyroidism is an endocrine disorder characterized by excessive secretion of parathyroid hormone, leading to significant alterations in calcium and phosphorus metabolism. Although most cases correspond to single parathyroid adenomas, advanced and multiglandular forms continue to represent a diagnostic and therapeutic challenge, particularly when associated with a cervical mass and suspicion of regional involvement. We present the case of a 58-year-old male patient with a history of severe hypercalcemia, recurrent nephrolithiasis, bone pain, and progressive enlargement of the left cervical region. Laboratory studies revealed markedly elevated parathyroid hormone levels, while cervical ultrasound, computed tomography, and sestamibi scintigraphy demonstrated a left parathyroid lesion associated with ipsilateral cervical lymphadenopathy. Due to the clinical and radiological findings suggestive of advanced disease, total parathyroidectomy associated with ipsilateral supraomohyoid neck dissection was performed. During the procedure, cervical neurovascular structures, including the recurrent laryngeal nerve, were identified and preserved. Postoperative evolution was favorable, with progressive decrease in serum calcium and parathyroid hormone levels, without major complications. Definitive histopathological analysis reported multiglandular parathyroid hyperplasia without evidence of malignant lymph node infiltration. This case highlights the importance of an individualized surgical approach in patients with advanced hyperparathyroidism associated with cervical mass, as well as the role of total parathyroidectomy and selective neck dissection in achieving adequate metabolic and locoregional control.