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Parathyroidectomy remains the only definitive cure and is now recommended for all symptomatic and asymptomatic patients meeting guideline criteria. Focused parathyroidectomy guided by dual-modality imaging and intraoperative PTH monitoring is effective for single-gland disease, while bilateral exploration is essential for in cases of multiglandular disease. Cure rates exceed 97% in experienced hands, with low complication rates. Surgery leads to improvements in bone mineral density, quality of life, and long-term survival. 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