The parathyroid glands are four small glands located behind the thyroid that regulate the calcium level in the blood. By controlling the amount of calcium in the body, the parathyroid glands control the strength and density of the bones, as well as other systemic functions. The most common reason for a parathyroidectomy, during which one or more of the parathyroid glands is removed, is the presence of a small benign tumor, known as an adenoma. The adenoma causes an overproduction of parathyroid hormone (PTH), resulting in hyperparathyroidism, an imbalance that can cause uncomfortable and serious symptoms.
The Parathyroidectomy Procedure
This surgery is performed may take between 1 and 3 hours depending on its complexity. Radioactive dye is administered intravenously to highlight the glands. One or more small incisions are made in the neck, and occasionally above the collar bone, and the diseased portion of the affected parathyroid is removed.
Even if the surgery is extensive, some parathyroid tissue is left in place to maintain normal function of the gland and prevent hypoparathyroidism (decreased parathyroid activity). In rare instances, when deemed advisable, such parathyroid tissue, instead of being left in the neck, is transplanted into the forearm.
While once a parathyroidectomy required a long incision, this surgery can now normally be performed through three minimally invasive techniques, reducing the risk of infection and shortening recovery time. These three methods are:
- Minimally invasive parathyroidectomy (MIRP)
- Video-assisted parathyroidectomy
- Endoscopic parathyroidectomy
In most cases of hyperparathyroidism, only one gland has to be removed and the minimally-invasive radio-guided parathyroid (MIRP) is the surgery of choice. MIRP involves only a local anesthetic, requires a much smaller incision and has a very high rate of success. This operation usually takes less than 30 minutes and the patient can return home within 1 to 2 hours. After the MIRP, patients can return to normal activities after just one day.
Risks of Parathyroidectomy
Where circumstances make a traditional surgery necessary, rather than a minimally invasive one, there is a greater risk of complications. While all parathyroid surgeries are considered quite safe, any surgical procedures carries some risk.
In addition to the risks inherent in any operation, which include adverse reaction to anesthesia, excessive bleeding, infection, and breathing problems, less than one percent of patients undergoing parathyroidectomy experience damage to the nerves controlling the vocal cords, which can affect speech. Patients requiring more extensive surgery could develop hypoparathyroidism, resulting in low calcium levels, which may require dietary supplementation with calcium and vitamin D.
Recovery from Parathyroidectomy
Recovery from a parathyroidectomy is typically uneventful. Most of the time, patients return home the same day as the procedure.Patients may experience numbness or tingling around the mouth for a day or two, the result of a low blood calcium level. After taking calcium supplements regularly, this symptom will abate, but they be limited soft foods for the first 24 hours after surgery. While they can resume normal activities within a day or two, they may not fully heal for up to 3 weeks.
After having had a parathyroidectomy, patients must have routine blood tests to check their calcium levels. In a certain percentage of cases, further surgery may be required at a later date.