Parathyroid surgery – what to expect
The parathyroid glands are involved in calcium metabolism. They release parathyroid hormone (PTH) in response to low calcium levels. The release of PTH is blocked by an increase in serum calcium. PTH causes the kidneys to increase the resorption of calcium and decrease the resorption of phosphorus. PTH also acts on bone and the intestine to increase serum calcium levels. Parathyroid surgery remains the single most effective treatment option for patients with primary hyperparathyroidism and requires removal of all abnormal parathyroid tissue.
Operations for thyroid and parathyroid disorders are safe and highly successful with a low complication rate. Parathyroid disease, or hyperparathyroidism, can be cured with minimally invasive parathyroid surgery. Since the disease results in overproduction of hormones, the goal is to remove the source of the problem. During Parathyroid gland surgery, the normal parathyroid glands are left intact while the glands that are overproducing are removed. The average cure rate, according to EndocrineWeb.com, is approximately 94%.
According to Parathyroid.com, the procedure has been successfully performed on patients for over 85 years. During parathyroid surgery, the surgeon must make an incision along the neck in order to access the necessary structures within the neck. Many people worry about scars after surgery. However, today’s surgeons are able to perform these procedures in a way that allows the wounds to heal better than ever. In most cases, patients are allowed to go home within an hour or two after parathyroid surgery.
EndocrineWeb.com states that about 96 percent of patients who undergo parathyroid adenoma surgery end up having only the parathyroid adenoma gland removed. This allows the doctor to leave three normal functioning glands intact. However, if additional glands are found to be enlarged, it may be necessary to remove additional glands.
Parathyroid surgery may be needed when:
- One or more parathyroid glands enlarge and become overactive, your blood calcium level may increase
- This condition is called primary hyperparathyroidism
- These tumors are nearly always benign, but they may cause other problems such as kidney stones, mood changes or depression, and weakened or painful bones
- The most common treatment for primary hyperparathyroidism is surgical removal of the abnormal gland or glands. Surgery can provide a permanent cure for this condition
Is there any other treatment for hyperparathyroidism besides surgery?
No. Surgery is the only effective treatment of hyperparathyroidism.
Parathyroidectomy is surgery to remove parathyroid glands or parathyroid tumours. Most parathyroidectomies are performed for primary hyperparathyroidism. The most common cause of primary hyperparathyroidism is a single parathyroid adenoma, which accounts for 80-90% of cases. Open parathyroidectomy will usually be needed for patients with 4-gland hyperplasia or a double adenoma. Double parathyroid adenomas do occur, but it is unclear how common they are. When individual patients with double adenomas are followed over a long period, some experience recurrence of hyperparathyroidism and are ultimately diagnosed with 4-gland hyperplasia.
A comprehensive 4-gland parathyroid exploration has traditionally been the standard of care for patients with primary hyperparathyroidism. – This procedure may be appropriate for patients with a single parathyroid adenoma. Today selected patients may have the equivalent chance of cure with targeted minimally invasive parathyroid surgery (MIP). Targeted surgery offers a smaller scar, reduced operating time and hospital stay. Minimally invasive parathyroid exploration allows smaller incisions and same-day hospital discharge and that it may also reduce the risk of laryngeal nerve injury and postoperative hypocalcaemia.
Parathyroid surgery guidelines
As a result of the large number of patients being diagnosed with primary hyperparathyroidism on the basis of laboratory testing, the National Institutes of Health (NIH) consensus panel has come up with the following guidelines for recommending surgery in asymptomatic patients:
- Serum calcium level more than 1.0 mg/dL above the upper limit of normal
- Marked hypercalciuria (> 400 mg/day) or renal stones
- Creatinine clearance less than 30% of normal
- Marked bone density reduction with a T-score lower than 2.5 at any site
- Age less than 50 years (if the problem is left untreated, many of these younger patients eventually develop complications of primary hyperparathyroidism)
- A patient who requests surgery or a patient for whom surveillance and follow-up are difficult or impossible
These guidelines are for asymptomatic patients. They do not apply, for example, to patients with a history of painful kidney stones when surgery is automatically indicated. The decision whether to provide surgical therapy for asymptomatic patients and those with minimal symptoms can be complicated. Many factors influence the decision to operate including the patient’s wishes, the surgeon’s experience, and the results of localization studies.
The most common cause of hypercalcemia in the outpatient setting is primary hyperparathyroidism. Surgery remains the only effective therapy for primary hyperparathyroidism and all patients should be referred for this treatment. Management of hypercalcemia from other causes must be tailored to the underlying diagnosis.
If you have questions about parathyroid gland problems or parathyroid surgery contact your local doctor, who will arrange for you to see a thyroid surgeon.