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05). There was no difference in rates of subjective dysphonia following tPTx or BNE (2.4% vs 2.3%, p 0.05), nor any difference in VC dysfunction when formally examined (4.9% vs 4.1%, p 0.05). In image-positive, first time, adult PHPT cases, tPTx is as safe and effective as BNE, with both achieving excellent short-term results with minimal complications. In image-positive, first time, adult PHPT cases, tPTx is as safe and effective as BNE, with both achieving excellent short-term results with minimal complications.Neurodevelopm