Introduction
A parathyroidectomy is a surgical procedure performed to remove one or more of the parathyroid glands. The parathyroid glands are small, lentil-sized glands located in the neck, usually situated behind the thyroid gland. Their primary function is to regulate calcium and phosphorus levels in the body by producing parathyroid hormone (PTH).
Indications
A parathyroidectomy is used to treat hyperparathyroidism, which occurs when your parathyroid glands are overactive. Hyperparathyroidism can be caused by a single benign tumour (adenoma) in one of the glands, enlargement of multiple glands (hyperplasia), or rarely, parathyroid cancer. The excess production of PTH leads to elevated calcium levels in the blood, which can cause various health problems.
Preoperative Instructions
Before the surgery, you will undergo several tests, including blood tests to measure calcium, phosphorus, and PTH levels. 24-hour urine tests are also sometimes required. Imaging studies like ultrasound, CT, nuclear medicine scans (sestamibi scans or SPECT-CT), or MRI may be performed to locate the abnormal parathyroid gland(s). These tests help determine the size, location, and functional status of the parathyroid glands and aid in surgical planning.
Procedure
Parathyroidectomy can be performed using different techniques, depending on the individual case and surgeon’s preference. The two main approaches are open exploration and minimally invasive parathyroidectomy surgery (MIPS). In an open parathyroidectomy, Dr Moar will make a small incision in the neck to access the parathyroid glands directly. The abnormal gland(s) are removed, and the normal ones are preserved. A minimally invasive parathyroidectomy, on the other hand, is performed using smaller incisions and specialised instruments. It is typically used for cases where a single adenoma has been identified preoperatively.
Postoperative Instructions
Most people are able to leave the hospital the morning following surgery. Calcium and PTH levels are monitored postoperatively to ensure they stabilise within the normal range. Most patients can resume normal activities within a few days to weeks, depending on the surgical approach and individual recovery.
Risks
Parathyroidectomy is generally considered a safe and effective treatment for hyperparathyroidism. The potential risks and complications are consistent with most surgeries, including bleeding, infection, damage to nearby structures such as the recurrent laryngeal nerve, and temporary or permanent changes in calcium levels.
Treatment Alternatives
Hyperparathyroidism may be managed with medications, particularly antiresorptive drugs and inhibitors of PTH secretion.