Parathyroidectomy is the surgical removal of one or more of the parathyroid glands.
There are usually four parathyroid glands, each about the size of a grain of rice, that are located behind the thyroid gland in the neck.
The parathyroid glands regulate the amount of calcium in the blood by the production of parathyroid hormone (PTH).
Sometimes one or more of these parathyroid glands overact (hyperparathyroidism) and cause the blood calcium level to rise above normal. This can lead to neuromuscular symptoms, osteoporosis and bone loss, and kidney stones. Most patients with hyperparathyroidism have one or more of these symptoms. The majority of patients with hyperparathyroidism have a single abnormal gland (a benign parathyroid adenoma). The remaining patients may have multiple abnormal parathyroid glands (parathyroid hyperplasia/multigland disease).
Minimally invasive operation
An imaging test called a sestamibi scan can localize up to 85-90% of parathyroid adenomas, allowing for a "minimally invasive" parathyroidectomy. Occasionally a neck ultrasound may also be done to localize parathyroid adenomas.
If a parathyroid adenoma is localized, a small incision is made to remove only the abnormal single gland. If parathyroid adenoma is not localized, a four-gland neck exploration will be performed.
Intraoperative PTH levels are measured before and after the offending gland is removed to determine the completeness of the procedure. If the PTH level fails to drop more than 50% from the baseline level, additional evaluation of the remaining three parathyroid glands is conducted.
The advantages of this operation include:
- A smaller incision and scar
- Less pain
- No need for a stay in the hospital
- Faster recovery
The standard parathyroidectomy procedure is the four-gland neck exploration. It is performed by making a small incision (4 cm) in the neck. All four glands are then identified, and the enlarged gland(s) are removed.
- Biopsies may be done of one or more of the normal glands.
- The PTH levels are checked during the parathyroidectomy to confirm the removal of the diseased parathyroid gland(s).
- Patients may be admitted for an overnight stay in the hospital following this standard operation.