The parathyroid glands consist of four individual pieces that are small and round. They’re attached to the back of the thyroid gland in your neck. These glands are a part of the endocrine system. Your endocrine system produces and regulates the hormones that affect your growth, development, body function, and mood.
Parathyroid glands regulate the amount of calcium in your blood. When the calcium level is low in your bloodstream, these glands 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 blood has too much calcium in it. 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 hyperparathyroidism. Primary hyperparathyroidism is twice as common in women as it is in men. Most people diagnosed with primary hyperthyroidism are over 45 years old. The average age of diagnosis is around 65 years.
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, a condition in which all four of the parathyroid glands are enlarged.
Calcium blood levels can rise even if only one gland is affected. Only one parathyroid gland is involved in about 80 to 85 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, if hypercalcemia is due to primary hyperparathyroidism, only surgery that removes the affected parathyroid gland(s) will provide a cure.
The most serious consequences of hypercalcemia are:
- kidney failure
- coronary artery disease
- an enlarged heart
- atherosclerosis (arteries with calcified fatty plaques that become hardened and abnormally function)
This may due to the buildup of calcium in the arteries and heart valves.
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 imaging that shows only one diseased gland prior to your surgery, you’ll likely have a minimally invasive parathyroidectomy with just a very small incision (less than 1 inch in length). Examples of techniques that may be used during this type of surgery, which may require additional small incisions, include:
In a radio-guided parathyroidectomy, your surgeon uses radioactive material that all four parathyroid glands will absorb. A special probe can locate the source of the radiation from each gland in order to orient and locate the parathyroid gland(s). If just one or two on the same side are diseased, your surgeon only needs to make a small incision to remove the diseased gland(s).
Video-assisted parathyroidectomy (also called endoscopic parathyroidectomy)
In a video-assisted parathyroidectomy, your surgeon uses a small camera on an endoscope. With this approach, your surgeon makes two or three small incisions for the endoscope and the surgical instruments in the sides of the neck and one incision above the breastbone. This minimizes visible scarring.
Minimally invasive parathyroidectomy allows 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 (affecting all four glands) will usually have three and a half parathyroid glands removed. The surgeon will leave the remaining tissue to control blood calcium levels. However, in some cases the parathyroid gland tissue that will need to remain in the body will be removed from the neck area and 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:
- ibuprofen (Advil)
- naproxen (Aleve)
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 or other adverse 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 a nerve in the neck that controls the vocal cords. In rare cases, you may have breathing problems. These usually go away several weeks or months after the surgery.
Blood calcium levels typically drop after this surgery. When the blood level of calcium gets too low, this is called hypocalcemia. When this happens, you might experience numbness or tingling in the fingertips, toes, or lips. This is easily prevented or 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 are considered to be experts. A skilled expert will likely have the lowest rates of surgery complications. Still, it’s important to remember that no surgery can be guaranteed as completely free of risks.
You may return home the same day of surgery or spend the night in the hospital. There’s normally some expected pain or discomfort after surgery, such as a sore throat. Most people can return to their normal activities within a week or two, but it can vary from person to person.
As a precaution, your blood calcium and PTH levels will be monitored for at least six months after surgery. You might take supplements for a year after surgery to rebuild bones that have been robbed of calcium.