The parathyroid glands consist of four individual pieces that are small and round. They’re attached to the thyroid gland in the neck. They’re a part of the endocrine system. Your endocrine system produces and regulates the hormones that affect your growth, development, and mood.
Parathyroid glands regulate the amount of calcium in the blood. When calcium levels are low, they release parathyroid hormone (PTH), which takes calcium from your bones.
Parathyroid gland removal refers to a type of surgery done to remove these glands. It’s also known as a parathyroidectomy. This surgery might be used if your body is producing too much calcium. This is a condition known as hypercalcemia.
Hypercalcemia occurs when blood calcium levels are abnormally high. The most common cause of hypercalcemia is an overproduction of PTH in one or more parathyroid glands. This is a form of hyperparathyroidism called primary hyperthyroidism. Primary hyperthyroidism is twice as common in women as it is in men. Most people diagnosed with primary hyperthyroidism are over 40 years old. The average age of diagnosis is 65.
You might also need parathyroid gland removal if you have:
- tumors called adenomas, which are most often benign and rarely turn into cancer
- cancerous tumors on or near the glands
- parathyroid hyperplasia, which is a condition in which all four parathyroid glands are enlarged
- a history of thyroidectomy, which is removal of the thyroid gland
Calcium blood levels can rise even if only one gland is affected. Only one parathyroid gland is involved in about 80 percent of cases.
Symptoms can be vague in the early stages of hypercalcemia. As the condition progresses, you may have:
- muscle aches
- a loss of appetite
- excessive thirst
- frequent urination
- abdominal pain
- muscle weakness
- kidney stones
- bone fractures
People with no symptoms may only need monitoring. Mild cases can be managed medically. However, only surgery that removes the affected glands will provide a cure.
The most serious consequences of hypercalcemia are:
- kidney failure
- coronary artery disease
- an enlarged heart
This may due to the buildup of calcium in the arteries and heart valves.
Types of Surgeries
There are different approaches to locating and removing the diseased parathyroid glands.
In the traditional method, your surgeon explores all four glands visually to see which are diseased and which should be removed. This is called a bilateral neck exploration. Your surgeon makes an incision in the middle to lower portion of your neck. Sometimes, the surgeon will remove both glands on a single side.
If you have only one diseased gland, you’ll likely have a minimally invasive parathyroidectomy. Examples of this type of surgery include:
In a radio-guided parathyroidectomy, your surgeon uses radioactive material that only the diseased glands will absorb. A special probe can locate the source of the radiation. Your surgeon only needs to make a small incision to remove the diseased gland.
In a video-assisted parathyroidectomy, your surgeon uses a small camera. They make two incisions in the neck so both the camera and instruments can fit.
In an endoscopic parathyroidectomy, your surgeon makes two or three small incisions in the neck and one near the breastbone. This minimizes visible scarring. This technique is similar to video-assisted surgery.
These minimally invasive methods allow for a quicker recovery. However, if not all of the diseased glands are discovered and removed, the high calcium levels will continue and there may be need for a second surgery.
People with parathyroid hyperplasia will usually have three and a half parathyroid glands removed. The surgeon will leave the remaining tissue to control calcium levels. However, the tissue will be implanted in an accessible place, like the forearm, in case it needs to be removed later.
You’ll need to stop taking medications that interfere with the ability of the blood to clot about a week before surgery. These include:
Your anesthesiologist will review your medical history with you and determine what form of anesthesia to use. You’ll also need to fast before surgery.
The risks of this surgery primarily include risks that are involved with any other type of surgery. First, general anesthesia can cause breathing problems and allergic reactions to the medicines used. Like other surgeries, bleeding and infection are also possible.
The risks from this particular surgery include injuries to the thyroid gland and vocal cords. In rare cases, you may have breathing problems. These usually go away several weeks or months after the surgery.
Blood calcium levels normally drop after this surgery. This is called hypocalcemia. You might experience numbness or tingling in the fingertips, toes, or lips. This is easily treated with calcium supplements, and this condition quickly responds to supplements. It’s usually not permanent.
You might also consider reaching out to an experienced surgeon to reduce risk factors. Surgeons who perform at least 50 parathyroidectomies per year have the lowest rates of surgery complications. Still, it’s important to remember that no surgery can be guaranteed as completely free of risks.
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You may return home the same day of surgery or spend the night in the hospital. There’s normally some pain or discomfort after surgery, such as a sore throat. Most people can return to their normal activities in several days.
As a precaution, your blood calcium levels will be monitored for at least six to twelve months after surgery. You might take supplements for a year after surgery to rebuild bones that have been robbed of calcium.