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

Parathyroidectomy for Hyperparathyroidism

In order to normalize blood calcium and PTH levels, a surgical procedure known as a parathyroidectomy is performed to remove a portion of the parathyroid tissue.

If the hyperparathyroidism is the result of a tumor, the goal of the surgery is to remove the diseased tissue while preserving as much of the healthy glands as possible. Depending on the circumstances, the surgeon may visually inspect each of the four parathyroid glands for signs of disease or localize the tumor preoperatively. A small incision is made in the neck to allow the surgeon to remove the adenoma. If the tumor is localized preoperatively, the surgeon will follow up with blood tests or radionuclide imaging to ensure that all of the abnormal tissue has been removed.

If the patient’s hyperparathyroidism is caused by an enlarged parathyroid gland, a parathyroidectomy will be used to remove most of the parathyroid tissue. One technique involves the removal of all but one-half of a single parathyroid gland. An alternative method involves excising all four parathyroid glands and then implanting a tiny portion of one gland in the patient’s neck or forearm.

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