Parathyroid surgery, also called a parathyroidectomy, is a medical procedure in which one or more parathyroid glands are removed. There are four parathyroid glands located behind the thyroid in the neck. Parathyroid surgery is a generally safe and effective operation, that may be required for patients suffering from primary hyperparathyroidism.
Hyperparathyroidism occurs when one or more parathyroid glands become overactive, causing it to produce too much parathyroid hormone (PTH). PTH helps balance calcium in the bloodstream by taking calcium from the bones when levels get too low. In primary hyperparathyroidism, the gland becomes enlarged and the excess PTH results in high calcium levels in the blood, bone thinning, joint pain, excessive urination, and cataracts, amongst other symptoms. A patient may have one affected gland, called a single adenoma; two or three diseased glands, called multiple adenomas; or all four parathyroid glands might be overactive, which is called four gland hyperplasia. Parathyroid surgery is the standard treatment for all three forms of primary hyperparathyroidism.
Parathyroid surgery can be performed as an open or minimally invasive surgery. During the open surgery, the patient is typically put under general anesthesia, so that the patient is not conscious and can feel no pain. A fairly large incision, about eight inches (20.3 cm) long, is made into the neck so that the surgeon can explore for the offending gland. Once found, the enlarged gland is cut away from the connecting tissues and removed from the body. If the patient has hyperplasia, some parathyroid tissue is left behind to try to encourage some normal PTH output.
Normally, the patient will be kept overnight and discharged the next day, barring complications. During recovery, the bandage should be kept dry and the patient may feel some pain and swelling around the incision. The risks of this surgery are very low, but include infection, blood loss, and temporary hoarseness. Calcium supplements may be prescribed to ensure that calcium levels don’t drop too low post-operation.
The minimally invasive radioguided parathyroid (MIRP) procedure is much preferred to open parathyroid surgery. In this procedure, the parathyroid tumors are made radioactive by a esstamibi scan so that the surgeon can differentiate the bad tissue from other structures in the neck before making an incision. An incision is then made in the front of the neck, under the adam’s apple, and a probe is inserted. The probe detects the radioactive tumor, or tumors, allowing the surgeon the surgeon to remove the enlarged glands without making a large incision.
Minimally invasive parathyroid surgery typically takes around 15 minutes and the patient may be discharged the same day. This surgery comes with the same risks as the open surgery, but much lower. Patients can usually return to their usual activities within a few days, but should be aware of keeping their bandage dry and noticing signs of numbness. The numb or tingling sensation is managed with calcium supplements and the sore throat that many parathyroidectomy patients experience can be treated with throat lozenges.
