What are two surgical options for treating 4 gland parathyroid hyperplasia?

The appropriate surgical options for treating four-gland parathyroid hyperplasia typically involve a combination of total parathyroidectomy with reimplantation of a small amount of parathyroid tissue to an alternative site, such as the forearm. This approach allows for the reduction of parathyroid hormone levels while preserving some parathyroid function, which is crucial in preventing postoperative hypoparathyroidism.

In parathyroid hyperplasia, simply removing all hyperplastic tissue can lead to a state where the body has no functional parathyroid glands remaining, particularly if all four glands are affected. Therefore, performing a four-gland resection followed by the re-implantation of a small portion of parathyroid tissue promotes the possibility of hormone production and helps maintain calcium homeostasis postoperatively.

The other options do not represent standard surgical management for this condition, hence reinforcing the appropriateness of the selected answer. For instance, removing less than four glands does not adequately address the hyperplastic condition. Similarly, radioactive iodine therapy is not applicable as it is used for thyroid conditions rather than parathyroid hyperplasia. Thyroidectomy in conjunction with parathyroidectomy is also not practical as both glands' operations are distinct and require specific interventions. Lastly,