Parathyroid gland removal

  • Definition
    • Parathyroidectomy is surgery to remove the parathyroid glands or parathyroid tumors. The parathyroid glands are right behind your thyroid gland in your neck. These glands help your body control the calcium level in the blood.

  • Alternative Names
    • Removal of parathyroid gland; Parathyroidectomy

  • Description
    • You will receive general anesthesia (asleep and pain-free) for this surgery.

      Usually the parathyroid glands are removed using a 2- to 4-inch surgical cut on your neck. During surgery:

      • The cut is usually made in the center of your neck just under your Adam's apple.
      • Your surgeon will look for the four parathyroid glands and remove any that are diseased.
      • You may have a special blood test during surgery that will tell if all the diseased glands were removed.
      • In rare cases, when all four of these glands need to be removed, part of one is transplanted into the forearm. This helps ensure your body's calcium level stays at a healthy level.

      The specific type of surgery depends on where the diseased parathyroid glands are. Types of surgery include:

      • Minimally invasive parathyroidectomy: You may receive a shot of a very small amount of radioactive tracer before this surgery. This helps highlight the diseased glands. If you have this shot, your surgeon will use a special probe, like a Geiger counter, to locate the parathyroid gland. Your surgeon will make a small cut (1 to 2 inches) on one side of your neck, and then remove the diseased gland through it. This procedure takes about 1 hour.
      • Video-assisted parathyroidectomy: Your surgeon will make two small cuts in your neck. One is for instruments, and the other is for a camera. Your surgeon will use the camera to view the area and will remove the diseased glands with the instruments.
      • Endoscopic parathyroidectomy: Your surgeon will make two or three small cuts in the front of your neck and one cut above the top of your collarbone. This reduces visible scarring, pain, and recovery time. This cut is less than 2 inches long. The procedure to remove any diseased parathyroid glands is similar to video-assisted parathyroidectomy.
  • Why the Procedure Is Performed
    • Your doctor may recommend this surgery if one or more of your parathyroid glands is producing too much parathyroid hormone. This condition is called hyperparathyroidism. It is often caused by a small non-cancerous (benign) tumor called an adenoma.

      Your doctor will consider many factors when deciding whether to do surgery and what type of surgery would be best for you. Some of these factors are:

      • Your age
      • Calcium levels in your urine and blood
      • Whether you have symptoms
  • Risks
    • Risks for anesthesia and surgery in general are:

      Risks for parathyroidectomy are:

      • Injury to the thyroid gland or the need to remove part of the thyroid gland
      • Hypoparathyroidism. This can lead to low calcium levels that are dangerous to your health.
      • Injury to the nerves going to the muscles that move your vocal cords. You may have a hoarse or weaker voice which could be temporary or permanent.
      • Difficulty breathing. This is very rare and almost always goes away several weeks or months after surgery.
  • Before the Procedure
    • Parathyroid glands are very small. You may need to have tests that show exactly where your glands are. This will help your surgeon find your parathyroid glands during surgery. Two of the tests you may have are a CT scan and an ultrasound.

      Before surgery, an anesthesiologist will review your medical history with you and decide what type of anesthesia to use. The anesthesiologist is the doctor who will give you the medicine that makes you asleep and pain-free during surgery and who monitors you during surgery.

      Fill any prescriptions for pain medicine and calcium you will need after surgery.

      Several days to a week before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), naproxen (Aleve, Naprosyn), and other drugs like these.

      Follow instructions about when to stop eating and drinking before surgery.

      Ask your doctor which medicines you should still take the day of surgery. Take them with a sip of water.

      If you smoke, try to stop. Ask your doctor or nurse for help.

      Arrive at the hospital on time.

  • After the Procedure
    • Often, people can go home the same day they have surgery. You can start your everyday activities in a few days. It will take about 1 to 3 weeks for you to fully heal.

      The surgery area must be kept clean and dry. You may need to drink liquids and eat soft foods for a day.

      Call your surgeon if you have any numbness or tingling around your mouth in the 24 to 48 hours after surgery. This is caused by low calcium. Your surgeon may want to see you and might suggest you can take calcium supplements until the symptoms go away.

      After this procedure, you should have routine blood tests to check your calcium level.

  • Outlook (Prognosis)
    • People usually recover soon after this surgery. Recovery is fastest when less invasive techniques are used.

      Sometimes, another surgery is needed to remove more of the parathyroid glands.

  • References
    • Sosa JA, Udelsman R. The parathyroid glands. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 39.