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Parathyroidectomy

Parathyroidectomy is surgery to remove the parathyroid glands or parathyroid tumors.

The parathyroid glands are right behind your thyroid gland in your neck. These glands help your body control the calcium level in the blood.

Hospital Stay: Hospital Stay: 3 days
Duration: Duration: 3.5 - 4 hrs
Cost Estimate: Cost Estimate: 3000 USD - 7000 USD These are indicative prices in Indian Hospitals

Your doctor may recommend this surgery if one or more of your parathyroid glands is producing too much parathyroid hormone. This condition is called hyperparathyroidism. It is often caused by a small non-cancerous (benign) tumor called an adenoma.
Your doctor will consider many factors when deciding whether to do surgery and what type of surgery would be best for you. Some of these factors are:

  • Your age
  • Calcium levels in your urine and blood
  • Whether you have symptoms

You will receive general anesthesia for this surgery. Usually the parathyroid glands are removed using a 2 – 4 inches surgical cut on your neck. During surgery:

  • The cut is usually made in the center of your neck just under your Adam’s apple.
  • Your surgeon will look for the four parathyroid glands and remove any that are diseased.
  • You may have a special blood test during surgery that will tell if all the diseased glands were removed.
  • In rare cases, when all four of these glands need to be removed, part of one is transplanted into the forearm. This helps ensure your body’s calcium level stays at a healthy level.
  • The specific type of surgery depends on where the diseased parathyroid glands are.

Types of surgery include:

  • Minimally invasive parathyroidectomy: You may receive a shot of a very small amount of radioactive tracer before this surgery. This helps highlight the diseased glands. If you have this shot, your surgeon will use a special probe, like a Geiger counter, to locate the parathyroid gland. Your surgeon will make a small cut of 1 to 2 inches on one side of your neck, and then remove the diseased gland through it. This procedure takes about 1 hour.
  • Video-assisted parathyroidectomy: Your surgeon will make two small cuts in your neck. One is for instruments, and the other is for a camera. Your surgeon will use the camera to view the area and will remove the diseased glands with the instruments.
  • Endoscopic parathyroidectomy: Your surgeon will make two or three small cuts in the front of your neck and one cut above the top of your collarbone. This reduces visible scarring, pain, and recovery time. This cut is less than 2 inches long. The procedure to remove any diseased parathyroid glands is similar to video-assisted parathyroidectomy.

Before the Procedure

Parathyroid glands are very small. You may need to have tests that show exactly where your glands are. This will help your surgeon find your parathyroid glands during surgery. Two of the tests you may have are a CT scan and an ultrasound.

  • Before surgery, an anesthesiologist will review your medical history with you and decide what type of anesthesia to use.
  • Several days to a week before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot, like aspirin, clopidogrel, warfarin etc.
  • Follow instructions about when to stop eating and drinking before surgery.
  • Ask your doctor which medicines you should still take the day of surgery. Take them with a sip of water.
  • If you smoke, try to stop.
  • Arrive at the hospital on time.

After the Procedure

  • Often, people can go home the same day they have surgery. You can start your everyday activities in a few days. It will take about 1 to 3 weeks for you to fully heal.
  • The surgery area must be kept clean and dry. You may need to drink liquids and eat soft foods for a day.
  • Call your surgeon if you have any numbness or tingling around your mouth in the 24 to 48 hours after surgery. This is caused by low calcium. Your surgeon may want to see you and might suggest you can take calcium supplements until the symptoms go away.
  • After this procedure, you should have routine blood tests to check your calcium level.

Outlook

People usually recover soon after this surgery. Recovery is fastest when less invasive techniques are used. Sometimes, another surgery is needed to remove more of the parathyroid glands.

The parathyroid glands are four, small, pea-shaped glands that are located in the neck on either side of the trachea and next to the thyroid gland. In most cases there are two glands on each side of the trachea, an inferior and a superior gland. Fewer than four or more than four glands may be present, and sometimes a gland / glands may be in an unusual location. The function of the parathyroid glands is to produce parathyroid hormone (PTH), a hormone that helps regulate calcium within the body.

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.

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