Parathyroidectomy Procedure
Overview
Parathyroidectomy is a type of endocrine surgery that removes one or more parathyroid glands. These four small glands, found behind the thyroid at the base of the neck, play an important role in controlling calcium levels in the blood.
The parathyroid glands produce parathyroid hormone (PTH), which helps manage the amount of calcium the body needs for healthy nerves, muscles, and bones. When a parathyroid adenoma or overactive parathyroid glands develop, calcium levels can become too high, leading to health issues.
Doctors often recommend parathyroidectomy to treat high PTH and elevated serum calcium. In many cases, only one gland causes the problem, so surgeons remove it to restore balance.
Key Points:
- 4 parathyroid glands behind the thyroid.
- Control blood calcium with PTH.
- Surgery treats high calcium or gland tumors.
- Often, just one gland is removed.
Reasons for Surgery
Treatment for Overactive Parathyroid Glands
Primary hyperparathyroidism occurs when one or more parathyroid glands produce too much parathyroid hormone. This can lead to high calcium levels in the blood, called hypercalcemia.
Symptoms may include weak bones, kidney stones, tiredness, confusion, muscle pain, and stomach problems. A non-cancerous growth called an adenoma most often causes this, but sometimes the glands become enlarged or, rarely, develop a cancerous tumor.
Surgeons usually recommend surgery when high blood calcium causes symptoms or when the condition affects younger patients, even if they have no symptoms. The goal is to bring calcium levels back to normal and relieve the signs of hyperparathyroidism.
Key Reasons for Surgery in Primary Cases
| Condition | Why Surgery Is Needed |
|---|---|
| Adenoma | Most common, causes overactive hormone production |
| Gland Enlargement | Several glands enlarged, raises calcium levels |
| High Blood Calcium | Leads to bone loss, kidney stones, and other symptoms |
Surgery for Parathyroid Problems Due to Other Diseases
Secondary hyperparathyroidism is different, as it is often linked to long-term conditions like kidney disease. In this form, the body makes more parathyroid hormone because calcium or vitamin D levels are low.
Doctors usually manage this overproduction with medicine or supplements. When symptoms continue after medical treatment, doctors may suggest surgery. Persistent hyperparathyroidism can lead to trouble with bones, muscles, or other organs if not addressed.
Symptoms Indicating a Need for Surgery
- Ongoing high parathyroid hormone levels.
- Weak bones or fractures.
- Problems with calcium balance despite other treatments.
Possible Complications
Parathyroid surgery can lead to certain risks, even though it is usually safe. Some people may develop an infection or a collection of blood (hematoma) under the skin, causing swelling or pressure.
Others might experience low calcium levels (hypocalcemia) if the parathyroid glands are damaged or removed, which could cause hypoparathyroidism. Voice changes may occur if nerves are affected, or a sore throat may result after anesthesia. Scarring at the incision site can happen.
Rarely, issues like injury to the thyroid gland, parathyroid cancer, or pancreatitis may arise. If the surgeon does not remove all overactive glands, high calcium levels can persist.
Common Risks Table
| Risk | Possible Outcome |
|---|---|
| Infection | Redness, pain, swelling |
| Hematoma | Neck swelling, pressure |
| Hypocalcemia | Numbness, muscle cramps |
| Scarring | Permanent mark at incision |
| Thyroid or Nerve Injury | Hoarseness, sore throat |
| Persistent High Calcium | Continued symptoms |
Getting Ready for Surgery
Before surgery, the care team usually tells patients not to eat or drink for some hours. They may use tools like ultrasound, sestamibi scan, or CT scan to plan the procedure. Arrange for someone to take you home after surgery.
What You Can Expect
Most patients have a set of imaging tests before the operation. These tests help doctors locate the exact parathyroid gland or glands that are causing problems. Some of the most common tests include:
- Sestamibi Scan: A small amount of radioactive dye goes into a vein. Overactive glands absorb the dye and appear on a special scanner.
- Ultrasound: This test uses sound waves to create images of the neck and helps spot swollen parathyroid glands or other concerns, like thyroid nodules.
- 4D CT Scan: A special CT scan with contrast dye gives clear pictures of the glands and their location.
- PET-Choline CT: Sometimes used when other tests do not show which gland is overactive, especially if a patient has already had another surgery.
These tests help the surgical team plan the best approach. Some patients need only one gland removed, while others may have more than one affected. Reviewing these test results allows the team to decide whether a minimally invasive surgery is possible or if a broader operation is needed.
Surgery Day
On the day of the operation, the anesthesiologist gives medicine to make the patient sleep through the procedure (general anesthesia). Sometimes, especially with minimally invasive surgery, doctors use only local anesthesia. In those cases, the patient stays awake but does not feel pain in the neck.
During surgery, the team may check hormone levels through a blood test to make sure all overactive glands are removed. The goal is to return parathyroid hormone levels to normal. There are two main surgical approaches:
| Approach | Description | When Used |
|---|---|---|
| Minimally invasive technique | Small cut, using imaging tests for guidance | If imaging finds a single overactive gland |
| Bilateral neck exploration | Surgeon looks at all four glands and removes any that are abnormal | If imaging is unclear or more than one gland is involved |
Steps During Surgery
- The surgeon makes a small incision in the lower neck.
- The surgeon locates and removes the overactive gland(s).
- The surgical team monitors nerves to the vocal cords to avoid injury.
- The surgeon closes the cut with stitches, usually leaving a thin scar.
Most scars fade and become hard to see over time. In many cases, especially with minimally invasive surgery, recovery starts soon after leaving the operating room.
Recovery and Life After Surgery
After the operation, most patients can eat and drink as usual. Many people go home the same day, but some may stay in the hospital overnight depending on the type of operation and their recovery. Common experiences after surgery include:
- Mild pain or discomfort at the site of the incision
- Hoarseness or a slight sore throat from the anesthesia
- Weak or hoarse voice (rare and often improves over the next days or weeks)
- Tiredness as the body heals
Patients should follow the healthcare team’s advice about returning to normal activity. Light activity is usually allowed soon after going home, but they should wait for approval before doing any heavy lifting or strenuous activity. Most people return to work or school within 1 to 2 weeks.
To help reduce the appearance of the scar, using sunscreen as recommended by a doctor is a good idea. The surgical area should be cared for as directed to avoid infection or other problems.
Quick Facts About Recovery
| Aspect | Typical Recovery |
|---|---|
| Hospital Stay | Often same-day; some stay one night |
| Return to Regular Eating | Usually right after surgery |
| Voice Changes | Usually mild and temporary |
| Returning to Work/School | 1-2 weeks for most people |
If any symptoms such as ongoing hoarseness, severe pain, or signs of infection (like fever, redness, or swelling) happen, the patient should call their care team. Follow-up visits help ensure healing is going well and that hormone levels are in the normal range again.
Tips for Healing
- Keep the incision clean and dry unless told otherwise.
- Protect the area from too much sun.
- Avoid strenuous activity until approved by the doctor.
- Attend follow-up appointments for checkups and blood tests.
Outcomes
Parathyroidectomy leads to a high rate of recovery in people with primary hyperparathyroidism. Most patients see their blood calcium return to a normal range after surgery. As high calcium in the blood drops, symptoms such as fatigue, weak bones, and bone pain often get better.
In many cases, bone strength and density begin to improve, helping prevent osteoporosis and reducing the risk of fractures. Other improvements often include:
- Lower risk of kidney stones.
- Enhanced bone health.
- Less risk of heart problems associated with high calcium.
- Fewer episodes of anxiety, depression, or seizures.
Possible Short-Term Effects
After the operation, some patients experience low calcium levels, which may cause tingling, numbness, or muscle cramps. Health care providers often suggest calcium supplements to help balance these levels. Most people regain normal calcium balance within weeks.
| Benefit | Observed Change |
|---|---|
| Blood calcium | Returns to normal |
| Bone health/osteoporosis | Improved |
| Kidney stones | Less frequent |
| Mood (anxiety, depression) | Often improved |
| Seizures | Reduced risk |
