Parathyroidectomy

The four parathyroid glands are situated in the lower neck adjacent to the thyroid. They are responsible for producing parathyroid hormone, also known as PTH. This hormone regulates calcium levels in the body by allowing calcium to be absorbed by the kidneys and gastrointestinal tract and stored in the bones. The parathyroid glands can become enlarged or develop tumors called adenomas. This causes the glands to produce an excessive amount of PTH. This results in a condition known as hyperparathyroidism, which can cause serious complications as calcium levels in the body rise to dangerous levels.

Diagnosing Parathyroid Gland Problems

  • Because of the high quality of the images produced, magnetic resonance imaging (MRI) studies are extremely effective in identifying tumors affecting the parathyroid glands.
  • A sestamibi scan uses a radionuclide to identify parathyroid adenomas. Once the radionuclide is administered to the patient, a gamma counter is used to determine if there is an increased amount of radionuclide uptake in the neck, which suggests abnormal tissue.
  • A CT scan enhanced with radioactive contrast allows the doctor to visualize abnormalities involving the parathyroid glands and the surrounding structures. CTs are most often used if a disease recurrence is suspected or when other tests have not been successful in identifying a tumor.
  • Ultrasounds provide relatively low-quality images, but they can be useful in identifying certain types of parathyroid tumors and concurrent tumors of the thyroid gland.
  • Blood samples may be taken from both internal jugular veins located on the sides of the neck. The samples will have different PTH levels, which will help determine the location of the adenoma.
Parathyroidectomy 1 UCI Head Neck - Parathyroidectomy
Parathyroidectomy 2 UCI Head Neck 1 - Parathyroidectomy

Diagnosing Hypercalcemia

The diagnosis of hypercalcemia is complicated by the fact that the symptoms, when present, are often vague and generalized. The most effective way to diagnose the condition is with blood tests to determine if high levels of parathyroid hormone and calcium are present in the blood. Another indication of hypercalcemia is a low level of calcium excretion, which can be detected through a urine test. These tests can also be useful in identifying causes of hypercalcemia unrelated to parathyroid function and prevent unnecessary surgery. Various imaging tests of the bones and other tissues may be used to rule out cancer as the underlying cause of the hypercalcemia.

Treating Hypercalcemia

If the level of calcium in the blood is only mildly elevated, a wait-and-see approach along with dietary adjustments may be all that is necessary. If calcium levels remain elevated or increase, medications may be prescribed to manage parathyroid activity.

Short-term use of steroids may be used to treat hypercalcemia resulting from high levels of vitamin D. Diuretics and IV fluids may be required if calcium levels become dangerously high.

Are There Risks?

All surgeries have risks, including bleeding, post-surgical infection, and reactions to anesthesia. In rare cases, patients may develop keloid scars or experience nerve damage affecting the function of the vocal cords. It is possible that blood calcium levels may drop too low following surgery, but this can be treated with vitamin D, calcium, and magnesium supplements.

Parathyroidectomy 3 UCI Head Neck 1 - Parathyroidectomy