Parathyroid Surgery

Parathyroidectomy is a surgical procedure that involves the removal of one or more of the parathyroid glands (these glands produce a hormone that increases levels of calcium in blood). The treatment is indicated for some patients with hyperparathyroidism (high levels of parathyroid hormone) as long term exposure to high blood calcium levels can cause significant health side effects. These includes osteoporosis, bone fractures, kidney stones, stomach ulcers and depression.

Parathyroidectomy is performed under general anaesthesia. The type of surgery depends on the type of parathyroid problem and the results of imaging investigations pre-operatively. The procedure can be performed by the following methods:

• Minimally invasive parathyroidectomy: for patients with a single abnormal parathyroid gland that has been identified on imaging this is the approach of choice. It allows exploration of one side of the neck through a smaller incision than is conventionally used.
• 4 Gland exploration: is the traditional approach to parathyroid surgery that involves a larger incision to allow exploration of both sides of the neck. This is indicated in patients who have hyperparathyroidism without an abnormal gland identified on imaging. It is also used if there is co-existing thyroid disease, in patients with hyperparathyroidism due to renal failure and patients with hereditary parathyroid diseases.

The abnormal gland (tumour) is identified and removed carefully. Sometimes more than one abnormal gland is removed. If all four glands are removed, a part of one of the glands is implanted in the forearm so that its function is not completely lost.

Like all operations, parathyroidectomy may involve complications, the most significant being a failed operation with a persistently high parathyroid hormone level. This occurs between 1-5% and is usually due to a missed parathyroid tumour. Further imaging investigations may be performed prior to a re-operation to find the missed gland.

Other complications can occur, such as:

• Bleeding – this may cause obstruction of the airway and require urgent return to theatre to evacuate the blood.
• Infection – uncommon
• Hypoparathyroidism – low levels of parathyroid hormone can occur and be associated with a low blood calcium
• Injury to nerves that supply the vocal cord – this is an uncommon occurrence that can significantly impact on a patients’ speech and swallow. Often it is only temporary and resolves by 6 months. A speech therapist can help with exercises to improve the voice in this setting.