Treatments

Sometimes, benign growths called adenomas appear on one or more of a person’s parathyroid glands. The cause of most parathyroid adenomas is unknown. However, about 10 percent are thought to be hereditary. Radiation exposure of the head and neck also may increase the risk of adenomas.
Adenomas cause the parathyroid gland to make more parathyroid hormone than the body needs, a condition called primary hyperparathyroidism. Too much parathyroid hormone upsets the body’s normal calcium balance, which increases the amount of calcium in the blood stream. A similar but less common condition, called secondary hyperparathyroidism, can occur in people with chronic kidney failure.
Women are twice as likely to develop pituitary adenomas as men, and often after menopause. Primary hyperparathyroidism may be caused by one adenoma, more than one adenoma or cancer.

Parathyroidectomy is the removal of one or more of the parathyroid glands, and it is used to treat hyperparathyroidism.

Hyperparathyroidism is a condition in which the parathyroid glands produce too much PTH. If there is too much PTH, calcium is removed from the bones and goes into the blood, and there is increased absorption of calcium from the intestine into the blood. This results in increased levels of calcium in the blood and an excess of calcium in the urine. In more serious cases, the bone density will diminish and kidney stones can form. Other non-specific symptoms of hyperparathyroidism include depression, muscle weakness, and fatigue. Every effort is made to medically treat or control these conditions prior to surgery. These efforts include avoiding calcium rich foods, proper hydration and medications to avoid osteoporosis.

There are two types of hyperparathyroidism, primary and secondary. The most common disorder of the parathyroid glands and one that causes primary hyperparathyroidism, is a small, tumor called a parathyroid adenoma. A parathyroid adenoma is a benign condition in which one parathyroid gland increases in size and produces PTH in excess. In most situations patients are unaware of the adenoma, and they are found when routine blood test results show an elevated blood calcium and PTH level. Less commonly, primary hyperparathyroidism may be caused by overactivity of all of the parathyroid glands, referred to as parathyroid hyperplasia.
With secondary hyperparathyroidism, the secretion of PTH is caused by a nonparathyroid disease, usually kidney failure.

Parathyroidectomy is necessary when calcium levels are elevated, if there is a complication of hyperparathyroidism, or if a patient is relatively young. Tests such as a high-resolution ultrasound or a nuclear medicine scan help to direct the approach preoperatively or intra-operatively by identifying the location of the overactive, enlarged gland. During a parathyroidectomy, the surgeon delicately removes one or more of the tiny parathyroid glands. In some situations, both sides of the neck are explored, while in other cases a direct approach is made through a small incision. In rare situations, the offending gland cannot be found.
Whereas preoperative tests help to identify hyperparathyroidism and to direct the surgical approach, PTH levels obtained during parathyroidectiomy help to guarantee the successful resection of the abnormal gland by demonstrating a return of the PTH levels to normal after the suspected parathyroid adenoma is removed. Using this method, a PTH determination is obtained immediately prior to the resection and compared to a PTH determination done ten minutes after the resection.

The following complications have been reported in the medical literature. Anyone who is contemplating surgery must weigh the potential risks and complications against the potential benefits of the surgery or any alternative to surgery.

• Damage to the recurrent laryngeal nerve with resultant weakness or paralysis of the vocal cord or cords – This is a rare but serious complication. Unilateral weakness results in a weak, breathy voice, and there will be problems swallowing. Bilateral vocal cord paralysis results in a relative normal voice; however, there is difficulty breathing, and the patient may ultimately require a tracheotomy.
• Bleeding or hematoma: In rare situations, a blood transfusion may be necessary because blood is lost during surgery. The surgeon can make arrangements for patients interested in these options.
• Damage to the remaining parathyroid glands resulting in problems with maintaining calcium levels in the blood.
• Need for further surgery: In some cases, surgical exploration fails to identify the abnormal parathyroid gland or multiple abnormal glands may be present. Further and more aggressive surgery may be necessary, such as an extensive surgical exploration of the neck or chest.
• Need for a limited or total thyroidectomy
• Prolonged pain, impaired healing, need for prolonged hospitalization, permanent numbness of the neck skin, poor cosmetic result, and/or scar formation.
• Recurrence of the tumor or failure to cure the tumor despite effective therapy.

Patients should contact their doctor if they notice:

• A sudden increase in the amount of bruising and pain associated with excessive swelling of the neck and difficulty breathing.
• A fever greater than 101.5° F that persists despite increasing the amount of fluid they drink and acetaminophen.
• Drainage from the wound.
• Spasms or severe cramps in the muscles or twitching of the face.