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Parathyroid Surgery

The parathyroid glands are small glands in the neck that control calcium levels in the body. Most people will have 4 glands, two on the left and two on the right side, and they are generally closely located to the thyroid gland. A normal gland is usually the size of a grain of uncooked rice, but when they become abnormal, they are typically much larger.

Parathyroid hormone (PTH)

Parathyroid hormone is constantly being secreted to keep calcium at a normal level. It acts on different parts of the body to increase the amount of calcium in the blood. When calcium levels are high, less PTH is released to bring down the calcium levels. This is called negative feedback. When parathyroids misbehave, they ignore the negative feedback and continue to secrete PTH despite calcium levels being high. PTH levels and calcium levels are measured in a blood test.

Parathyroid adenoma

When PTH levels are elevated, usually one of the four glands is misbehaving. We call this an adenoma and surgical removal is generally the best way to manage it. Ninety-nine percent of the time this is a benign process (i.e. not a cancer). The goal of surgery is to remove the abnormal gland, to relieve you of your symptoms, and prevent long term consequences of high PTH levels, such as osteoporosis or kidney stones.

Investigations

Hyperparathyroidism (high parathyroid hormone levels) can be due number of reasons. If not already performed, some blood tests and urine tests are required to confirm a diagnosis. If the blood tests are consistent with an abnormal parathyroid gland, then further investigations such as a neck ultrasound, sestamibi scan and CT-scan are required to help locate an abnormal gland. This determines the surgical approach required to fix the problem.

Surgery

All types of parathyroid surgery require a general anaesthetic and an incision in the neck. Hospital stay is usually just one night. Pain in the neck and a sore throat is common. Most people manage with paracetamol only but occasionally need stronger analgesia.

Minimally invasive Parathyroidectomy (MIP)

Depending on the location of the abnormal gland, a smaller incision can be used. The operation is generally shorter in duration and more targeted, hopefully limiting the risk of bleeding and damage to other structures.

Neck Exploration

This can be performed on one side (unilateral) or bilateral (both sides). A neck exploration is required when the imaging tests have not confidently localised one abnormal parathyroid gland. It is also indicated with repeat parathyroid surgery. These operations tend to be longer and have a slightly higher risk, but hospital stay is generally the same duration of one to two nights.

Risks of surgery

The complications are similar to thyroid surgery (see Thyroid Surgery page). Some other more specific complications include low calcium (hypocalcaemia) and further surgery.