Parathyroid Surgery

There are typically four parathyroid glands located near the main thyroid in the neck. These glands are responsible for producing parathyroid hormone (PTH), which controls calcium metabolism in the bones and urine. Normal parathyroid glands are no more than the size of a sunflower seed. Abnormal glands swell to approximately the size of a grape.

The most common parathyroid disease is overactive parathyroid or hyperparathyroidism. In approximately 90% of patients affected, one of four of the parathyroid glands is overactive, but a small portion of the population experiences more than one overactive gland. When a gland is overactive, it increases levels of PTH, which causes the body to absorb calcium from the bones. This weakens the bones and causes osteoporosis. It can also lead to kidney stones and extreme damage to the kidneys, as well as depression, muscle symptoms, and fatigue.

Diagnosis

Typically, patients see a doctor when blood calcium levels or PTH levels are high. Once an official diagnosis is made, doctors might ask patients to undergo a radiological exam. This uses Sestamibi radioactive marker in conjunction with CT imaging to determine what tissue is abnormal.

Treatment

Once the evaluation is complete, most patients are referred for surgery to remove the affected gland. Doctors might also use an intra-operative parathyroid hormone blood test (IOPTH) to measure levels of parathyroid hormone before and after removing the affected gland. This helps doctors determine if the correct gland was targeted and removed.

Risks

Parathyroid surgery is considered safe, but as with all surgeries, there are some risks. These include:
  • Temporary or permanent hoarseness
  • Low calcium levels, which are treated with oral supplements
  • Infection
  • Bleeding
  • Inability to locate the affected gland, which results in permanent hyperparathyroidism