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What Is a Parathyroidectomy?

Medically Reviewed by Dan Brennan, MD on June 09, 2021

The parathyroid glands are four tiny glands that, like the thyroid, are in the neck but closer to the spine. They make parathyroid hormone (PTH), which regulates levels of calcium and other minerals in the blood.

A parathyroidectomy is a surgical procedure done when one or more of your parathyroid glands swell and produce excess PTH. This condition is called hyperparathyroidism.

Too much PTH causes your blood calcium levels to soar way past average (hypercalcemia). 

Reasons to Get a Parathyroidectomy

The most common reason why people get parathyroidectomies is that they have hyperparathyroidism.

Causes of Hyperparathyroidism

Hyperparathyroidism can be caused by:

  • Adenomas, or benign tumors that occur on one of the parathyroid glands. These noncancerous tumors make the gland overreact and make too much PTH. 
  • A condition called hyperplasia, in which two separate parathyroid glands swell up, causing them both to produce excess PTH. 
  • Radiation as medical treatment, near the parathyroid glands. 
  • Cancer in the parathyroid, which is quite uncommon. 
  • Rare cases of hormonal issues passed down from generation to generation. 

Symptoms of Hyperparathyroidism

Blood calcium level overload is a sign of hyperparathyroidism. It shows up as the following conditions: 

  • Weakened bones. The PTH signals that call for more calcium in the blood cause the bones to release more calcium than they should. This causes your bones to become less healthy and more susceptible to breaking. 
  • Heightened absorption. PTH also causes your body to take in more calcium than it needs from food.
  • Damage to the kidneys. Your kidneys will also retain more calcium than necessary instead of releasing it in your urine. Too much calcium in the kidneys causes you to have kidney stones.

These conditions can cause the following to occur: 

  • Pain in the joints
  • Weak muscles
  • Fatigue
  • Depression
  • Difficulty concentrating
  • Irregular eating habits
  • Nausea 
  • Vomiting
  • Feeling confused 
  • Forgetting things
  • Irregular urination
  • Constipation

Additionally, high calcium blood levels are also associated with high blood pressure and osteoporosis.

Risks of a Parathyroidectomy

A parathyroidectomy carries some risks, among them:

  • Injury. Damage may be done to the (laryngeal) nerve that controls your vocal cords, to your esophagus, or to your windpipe (trachea). 
  • Permanently low calcium. Depending on your body and whether or not you get one or more parathyroids removed, you could have a permanently low rate of blood calcium after your surgery. You might have to take calcium-vitamin D supplements to stay healthy. 
  • Bleeding. The operation could result in out-of-control bleeding, though this is rare. 
  • Buildup of scar tissue. This could result in a need for added surgery. 

Variations of Parathyroidectomies

A parathyroidectomy is a serious surgery, though it may be minimally invasive. 

Traditional Parathyroidectomy. A surgeon makes a four-centimeter incision into a neck muscle to access your glands. After reaching the thyroid and then the parathyroids, the surgeon will examine the parathyroids and remove the infected or damaged ones. They will also take a PTH-level test to confirm which parathyroid(s) to remove.

Following surgery, you will have to stay overnight in the hospital.

Minimally Invasive Surgery. When an adenoma is causing your problem, a neck ultrasound is usually enough to find out where it's located. The surgeon will be able to precisely target whichever parathyroid gland needs to be removed.

The remaining parathyroid glands are tested if your body's PTH level does not even out. But usually, you feel less pain, have more minor scars, do not have to stay in the hospital, and will have a speedy recovery.

Transoral Parathyroidectomy. This modern technique does not require any incision at all.  Instead, the surgeon accesses your parathyroid through your mouth and removes the gland from there.  While still serious, this method leaves no visible scar and is easier to recover from.

Preparation and Aftercare for Parathyroidectomy

While deciding on whether you need surgery, your health care provider will need to conduct one or more of the following tests:  

  • Ultrasound 
  • Sestamibi nuclear scan, which involves injecting your body with a small amount of radiation
  • Computed tomography or CT scan, a targeted but full-body X-ray exam
  • Magnetic resonance imagining (MRI)
  • Blood tests
  • Urinalysis
  • Bone density screening

Preparation. Stop taking aspirin or similar NSAIDs a week before your scheduled surgery. Get a good night's rest the night before surgery, and don't eat or drink anything on the day of the operation. 

Aftercare. Usually, aftercare is relatively minimal. In most cases, you can go home within 24 hours after the procedure. Typically, you can get back into your usual activities within three weeks. 

You may also need to limit your food intake in favor of liquids and soft foods for a while. And keep your incision area clean and protected.  If you notice any redness or swelling in the area, contact your surgeon. 

Additionally, after this surgery, you should get routine checkups on your blood calcium levels. Your health care provider will want to ensure that your remaining parathyroids are all working in the way that your body needs.

WebMD Medical Reference

Sources

SOURCES:

Cleveland Clinic: "Hyperparathyroidism."

Department of Surgery at the University of Colorado School of Medicine: "Parathyroidectomy."

Johns Hopkins Medicine: “Parathyroidectomy,” “Transoral Parathyroidectomy: Hetty’s Story,” "Parathyroid Surgery at Johns Hopkins."

National Institute of Biomedical Imaging and Bioengineering: "Computed Tomography (CT)."

NHS The Hillingdon Hospitals: "Nuclear Medicine Parathyroid Scan."

UCSF Endocrine Surgery: “Parathyroidectomy.”

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