Would you consider exploratory surgery in a young patient with normocalcemic hyperparathyroidism that meets one or more criteria for parathyroidectomy but has no localized pathology on advanced neck imaging?

If the patient has any complications that could be caused by primary hyperparathyroidism surgery would be appropriate done by a highly experienced parathyroid surgeon. It is not uncommon for imaging to be negative in patients with relatively mild parathyroid problems.