Recurrent hyperparathyroidism and forearm parathyromatosis after total parathyroidectomy

Because of frequent recurrence, TPFA should be abandoned as a treatment of renal hyperparathyroidism. In multiple endocrine neoplasia type I, subtotal parathyroidectomy has similar outcomes to TPFA. Forearm autotransplantation can be complicated by parathyromatosis, and surgeons should be prepared for reoperative en bloc resection.