Parathyroidectomy

Definition

Parathyroidectomy is the removal of one or more of the parathyroid glands. The parathyroid glands are usually four in number, although the exact number may vary from three to seven. They are located in the neck in front of the Adam's apple and are closely linked to the thyroid gland. The parathyroid glands regulate the balance of calcium in the body.

Purpose

Parathyroidectomy is usually done to treat hyperparathyroidism (abnormal over-functioning of the parathyroid glands).

Precautions

Parathyroidectomy should only be done when other non-operative methods have failed to control the patient's hyperparathyroidism.

Description

Parathyroidectomy is an operation done most commonly by a general surgeon, or occasionally by an otolaryngologist, in the operating room of a hospital. The operation begins when the anesthesiologist anesthetizes or puts the patient to sleep. The surgeon makes an incision in the front of the neck where a tight-fitting necklace would rest. All of the parathyroid glands are identified. The surgeon then identifies the gland or glands with the disease and confirms the diagnosis by sending a piece of the gland(s) to the pathology department for immediate microscopic examination. The glands are then removed and the incision is closed and a dressing is placed over the incision.

Patients generally stay overnight in the hospital after completion of the operation and may remain for one or two additional days. These procedures are reimbursed by insurance companies. Surgeon's fees typically range from $1,000–$2,000. Anesthesiologists charge for their services based on the medical status of the patient and the length of the operative procedure. Hospitals charge for use of the operating suite, equipment, lab and diagnostic tests, and medications.

Preparation

Prior to the operation, the diagnosis of hyperparathyroidism should be confirmed using lab tests. Occasionally, physicians order computed tomography scans (CT scans), ultrasound exams, and/or magnetic resonance imaging (MRI) tests to determine the total number of parathyroid glands and their location prior to the procedure.

Aftercare

The incision should be watched for signs of infection. In general, no specific wound care is required.

The level of calcium in the body should be monitored during the first 48 hours after the operation by obtaining frequent blood samples for laboratory analysis.

Risks

The major risk of parathyroidectomy is injury to the recurrent laryngeal nerve (a nerve that lies very near the parathyroid glands and serves the larynx or voice box). If this nerve is injured, the voice may become hoarse or weak.

Occasionally, too much parathyroid tissue is removed, and the patient may develop hypoparathyroidism (underfunctioning of the parathyroid glands). If this occurs, the patient will require daily calcium supplements.

Sometimes not all of the parathyroid glands are found in the initial operation. A fifth or sixth gland may be located in an aberrant location such as the chest (ectopic parathroid). If this occurs, the patient's hyperparathyroidism may not be corrected, and a second procedure may be required to find the other gland(s).

Hematoma formation (collection of blood under the incision) is a possible complication of any operative procedure. However, in procedures that involve the neck it is of particular concern, because a rapidly enlarging hematoma can obstruct the airway.

Infection of the surgical incision may occur, as with any operative procedure, but this is not common.

Normal results

Most patients require only two or three days of hospitalization to recover from the operation. They usually can resume most of their normal activities within one to two weeks.

BOOKS

Kaplan, Edwin. "Thyroid and Parathyroid." In Principles of Surgery. 6th ed. Ed. Seymour I. Schwartz, et al. New York: McGraw-Hill, 1994.

"Parathyroidectomy." In The American Medical Association Encyclopedia of Medicine, ed. Charles B. Claymon. New York: Random House, 1989.

OTHER

"Parathyroidectomy." ThriveOnline. <http://thriveonline.oxygen.com>.

Mary Jeanne Krob, MD, FACS

KEY TERMS

Anesthesiologist—A physician who specializes in anesthetizing patients for operations.

Ectopic parathyroid tissue—A condition where the thyroid tissue is located in an abnormal place.

Hyperparathyroidism—Abnormal over-functioning of the parathyroid glands.

Hypoparathyroidism—Abnormal under-functioning of the parathyroid glands.

Otolaryngologist—A surgeon who treats people with abnormalities in the head and neck regions of the body.