Parathyroidectomy

About Parathyroidectomy

Parathyroidectomy removes one or more overactive parathyroid glands, small glands behind the thyroid that regulate calcium in the blood. It is the only curative treatment for primary hyperparathyroidism, a common endocrine disorder, especially in older women, which causes high calcium levels and can lead to kidney stones, bone loss and a range of other symptoms. In most cases a single benign adenoma is responsible, while a minority of patients have enlargement of all four glands, called hyperplasia, or more than one adenoma. Imaging such as sestamibi scanning, ultrasound and four dimensional CT is used to locate the abnormal gland before surgery, which allows a focused minimally invasive operation through a small neck incision. Intraoperative measurement of parathyroid hormone exploits its very short half life: a sufficient fall in the hormone level shortly after removal of the gland indicates that the abnormal tissue has been removed. When all glands are enlarged, surgeons perform a subtotal parathyroidectomy, leaving a small remnant, or remove all glands and transplant a small piece into a muscle, often in the forearm. The operation is also used for secondary and tertiary hyperparathyroidism in kidney disease. Complications are uncommon and include temporary low calcium, which can be pronounced when bones rapidly take up calcium after surgery in hungry bone syndrome, permanent hypoparathyroidism, recurrent laryngeal nerve injury causing hoarseness, bleeding and persistent disease. The first successful parathyroidectomy was performed by Felix Mandl in Vienna in 1925.