MEN 1 is a genetic syndrome in which hyperparathyroidism is present in 90% of the cases. The correct treatment is essential to obtain complete recovery, keeping in mind that the disease is often multiglandular.

Between 1975 and 2008 we operated 1160 Primary HPT. Among them 24 were classified as MEN 1 and in 21 we found a MGD.

We always explored the entire neck and removed the thymus. We performed subtotal parathyroidectomy in 8 and total parathyroidectomy with autotransplant and criopreservation in 13 (in 1 case we had to transplant criopreserved tissue). In 4 cases there were supernumerary glands. Only in 3 cases we removed one gland which was clearly enlarged but the others were all examined (the ioPTH was essential to make a final decision). In 3 cases we reoperated patients coming from other surgeons, performing a total parathyroidectomy with AT and criopreservation. We had no complications except 1 hypoparathyroidism, a normal value of calcium and PTH was obtained in 3 months in all cases and all patients are controlled every year.

We therefore think that the best treatment for primary HPT in MEN 1 is a complete exploration of the neck identifying all glands: the ioPTH is essential to assess the best operation but in many cases this is a multiglandular disease and the treatment of choice has to be either a total PTx with AT and criopreservation or a subtotal PTx. In order to prevent recurrences the less hyperplastic gland must definitely be chosen.