What is Parathyroid Surgery?
Parathyroid glands are 4 small pea-shaped glands located in the neck just behind the thyroid glands. Parathyroid surgery involves removal of one or more parathyroid glands.
Parathyroid Hormone (PTH) is released by these glands in response to low calcium levels in the blood. PTH causes the mobilisation of calcium from bones. It also causes the release of vitamin D from kidneys and absorption of calcium from small intestine thus regulating blood calcium.
When is Parathyroid Surgery Indicated?
Certain parathyroid conditions requiring surgery include:
- Parathyroid cancer
- Benign tumours of one or more parathyroid gland
- Enlargement of the glands (hyperplasia)
- Over-active parathyroid gland (hyperparathyroidism)
What Happens if Parathyroid Disorders are Left Untreated?
Parathyroid problems cause abnormal calcium levels in the blood. If left untreated, it can cause osteoporosis, hypertension, kidney failure and heart problems like atherosclerosis.
Preparing for the Surgery
- Before surgery, you will receive a complete medical evaluation and your doctor will discuss the surgery in detail.
- Your doctor will perform a physical exam and take a medical history.
- PTH blood test, ECG and chest X-ray may be ordered.
- You may have to take a stress test to evaluate heart and lung function.
- Talk to your doctor about the medicines you are taking prior to the procedure. Inform your doctor if you are allergic to any medicines or anaesthesia.
- Do not eat or drink 6-8 hours before the surgery. Arrange for someone to drive you home.
How is Parathyroid Surgery Performed?
Parathyroid surgery is usually performed under general anaesthesia involving any one of the following approaches:
Bilateral Neck Exploration
This is a traditional method to perform parathyroid surgery. Your surgeon will use a large incision to explore all the 4 glands. The diseased glands are identified and removed during the surgery.
Video-assisted Parathyroidectomy
Recently, a minimally invasive technique that uses an endoscope is used to perform the surgery. The endoscope is a long, thin, flexible tube with a tiny video camera and light at the end. Images from the camera are transmitted to a large monitor for your surgeon to view the parathyroid glands.
- Your surgeon will make two small incisions at the sides of your neck and one above the breastbone.
- An endoscope is inserted through one of the incisions.
- Small surgical instruments are inserted through the other two incisions.
- Parathyroid glands are carefully removed avoiding damage to nearby nerves.
Radio-guided Parathyroidectomy
For this procedure, you receive a shot of radioactive tracer which will be absorbed by the parathyroid glands. Your surgeon uses a special instrument called a Geiger counter to identify the diseased gland. A small cut is made at the side of your neck to carefully remove the gland.
The incisions are closed with sutures or a protective strip of surgical glue called collodion. In people with all 4 glands affected, a small piece of parathyroid tissue may be left behind to control blood calcium levels.
What Happens After Surgery?
You will have to stay a day or two at the hospital. Pain medications will be given to manage pain. Calcium levels are closely monitored. At home, you will be instructed to avoid any strenuous activities. You can eat and drink normally. Regularly follow up with your surgeon for complete recovery. You may be required to take parathyroid hormone pills depending upon the number of glands removed.
What are the Complications of Parathyroid Surgery?
Complications are rare but can include:
- Bleeding and infection at the surgical site
- Temporary hoarseness of voice
- Low blood calcium levels