Parathyroidectomy Surgery

What is a parathyroidectomy?

A parathyroidectomy is the surgical removal of one or all of the four PARATHYROID GLANDS.

What are the indications for a parathyroidectomy?

A parathyroidectomy is performed when one or all of the parathyroid glands are producing too much PARATHYROID HORMONE. This is known as HYPERPARTHYROIDISM. It is also indicated for cancer of the parathyroid gland.

How does the surgeon know which parathyroid glands are overactive?

The surgeon examines the parathyroid glands during the parathyroidectomy procedure, as the overactive glands will be enlarged (hypertrophied). Additionally, special parathyroid tests (Sestambi scanning or SPECT scanning) can be used to help identify overactive glands. Usually just one gland is overactive (single adenoma). However, in the case that all four glands are overactive, usually only 3 to 3 1/2 glands are removed. This allows for the preservation of some functioning parathyroid tissue, otherwise HYPOPARATHYROIDISM would result. During surgery, small biopsies (pieces of tissue) can be taken to confirm the gland is overactive. In addition, special medicine can be injected into the body that will dye the parathyroid glands a certain color for easier identification.

What is involved with a parathyroidectomy?

The patient is fully asleep (under general anesthesia) for this procedure. As the parathyroid glands are located behind the THYROID GLAND, the initial part of the procedure is similar to a THYROIDECTOMY. An incision (a precise surgical cut) is made across the lower part of the neck. Layers of skin and muscle are lifted up, and the thyroid gland is identified. Next, all four parathyroid glands are located and examined to determine which are enlarged (hypertrophied). The affected tissue is then removed. As mentioned above, in the case of all four glands being enlarged, some parathyroid tissue will be left in place.

The muscle and skin layers are then replaced, and the surgical incision is closed.
A hospital stay of less than a week is usually required.

What are the risks and complications of a parathyroidectomy?

Significant blood loss and wound infections are extremely infrequent with this procedure. HOARSENESS of the voice can result if the nerve supplying the voice box (VOCAL CORDS) is damaged. However, this is uncommon in the hands of an experienced surgeon.

Additionally, if too much parathyroid tissue were removed, not enough parathyroid hormone would be produced (HYPOPARATHYROIDISM). As a result, calcium levels in the body would drop causing painful muscle spasms. In contrast, if not enough overactive parathyroid tissue is removed, HYPERPARATHYROIDISM, and a repeat surgical procedure may be necessary.