Parathyroid Surgery

 

 
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What are parathyroid glands?

The parathyroid glands consist of four small, round-shaped glands. They are attached to the thyroid gland in the neck and are part of the endocrine system. Your endocrine system produces and regulates the hormones that affect your growth, development and mood.

Parathyroid glands regulate the amount of calcium in the blood. When calcium levels are low, they release parathyroid hormone (PTH), which takes calcium from your bones.


What is Hypercalcemia?

Hypercalcemia is a condition where your body is producing too much PTH which causes your calcium to be too high. Symptoms can be vague in the early stages of hypercalcemia. As the condition progresses, you may experience:

  • fatigue
  • depression
  • muscle aches
  • a loss of appetite
  • nausea
  • vomiting
  • excessive thirst
  • frequent urination
  • abdominal pain
  • constipation
  • muscle weakness
  • confusion
  • kidney stones
  • bone fractures

People who don’t experience any symptoms may only need monitoring. Mild cases can be managed medically, however, only surgery that removes the affected glands can provide a cure.


why is Parathyroid Surgery necessary?

Your doctor may recommend parathyroid surgery for the following reasons:

  • Parathyroid adenoma- a tumor of one or more parathyroid glands which is benign (not cancer), but produces too much parathyroid hormone which causes hypercalcemia.
  • Parathyroid hyperplasia - a condition in which all four parathyroid glands are enlarged and producing too much parathyroid hormone.
  • arathyroid cancer (very rare).

What are the risks of surgery?

As with other types of surgery, there are some risks to be aware of:

  • General anesthesia is used for surgery and can cause breathing problems and allergic reactions to the medicines used.
  • Like other surgeries, bleeding and infection are possible but very rare.
  • The risks from this particular surgery include injuries to the nerves that go to the vocal cords which can cause voice changes or breathing problems.
  • Hypocalcemia – low blood calcium levels which can cause numbness or tingling in the fingertips, toes, or lips.  This is treated with calcium supplements and usually resolves within a couple of weeks after surgery and is rarely permanent.

What will my scar look like?

There are two general approaches to parathyroid surgery and each approach depends on the reason for surgery. 

  1. Four gland exploration. An incision is made in the lower neck about 4 to 5 cm in length.  This approach is generally needed for the following reasons:
    • You have parathyroid hyperplasia and need  3 ½ glands removed. 

    • You have more than one parathyroid adenoma (2-3% of cases) or the gland cannot be found with imaging studies before surgery.

  2. Minimally invasive parathyroidectomy- An incision is made in the lower neck about 1-2 cm in length.  This can be done for patients who have a single abnormal gland which can be found on imaging before surgery.

Regardless of the type of surgery you need, the incision and scar care is the same.  The incision is closed with dissolving stitches and either skin glue or steri strips.  The incision can get wet in the shower 1-2 days after surgery.  It will have some mild to moderate swelling for about two weeks.  The most important care for your scar is to keep it out of the sun.  In Colorado the sun rays are intense and can cause scars to be more visible.  You should keep the area out of direct sunlight, cover it, or apply sunscreen to the scar daily once the skin has healed.  This should be continued for the first six months after surgery.  Generally, after about a year, with good care to the site, most scars are barely visible.