Parathyroid Surgery
About the Parathyroid Gland
Most people have four parathyroid glands that lie adjacent to the thyroid. Each gland is approximately the size and shape of a grain of rice. Other than their close proximity, there is no relationship between the thyroid and parathyroid glands.
The parathyroid glands produce parathyroid hormone (PTH) that controls the body's calcium levels. The most common disease is primary hyperparathyroidism, due to overproduction of PTH, which increases calcium levels. Symptoms can include osteoporosis, kidney stones, abdominal pain, muscular aches and pains, and tiredness.
What is involved in Parathyroid Surgery?
Approximately 85% of patients with primary hyperparathyroidism are suitable for minimally invasive parathyroidectomy. The remaining 15% require open parathyroidectomy. Dr O'Neill will discuss the appropriate operation at your pre-operative visit.
Most patients stay in hospital only one night post-operatively. PTH and calcium levels are checked to ensure primary hyperparathyroidism is cured.
Minimally Invasive Parathyroidectomy In more than 85% of patients, only one of the four parathyroid glands is overactive. Scans (Parathyroid sestamibi, ultrasound and sometimes CT) help identify which gland is abnormal. If scans identify only one abnormal gland, it can be targeted for removal via a 2 to 2.5cm incision directly over the gland. Primary hyperparathyroidism is cured in 95% of patients after minimally invasive parathyroidectomy.
Open Parathyroidectomy In some patients, overproduction of PTH involves more than one gland or imaging doesn't localise the disease to one gland. This requires a slightly larger incision (4 to 5cm), inspection of all four glands and removal of any abnormal glands. Sometimes during minimally invasive surgery, the abnormal gland cannot be found and the surgeon will convert to open parathyroidectomy.
What are the risks of Parathyroid Surgery?
Although uncommon, there are risks:
Voice changes The nerves supplying the voice run closely adjacent to the parathyroid glands. Great care is taken to protect these nerves. Long-term voice changes are uncommon and occur in less than 1% of patients. Vocal cord movement is checked before and after surgery with a flexible telescope through the nose.
Low or persistently high calcium levels Up to 5% of patients may not be cured and calcium levels may remain persistently raised after surgery. In some patients, further surgery can still cure the condition. Occasionally calcium levels may become too low after surgery, usually due to "stunning" of remaining glands, which almost always recovers. Tablets can be given to boost calcium levels if needed, and patients are usually weaned off these over the following weeks.
Bleeding The parathyroid glands have a rich blood supply. Bleeding after surgery is very uncommon (fewer than 1% of patients) but may occasionally require a second operation.
Wound healing problems Most scars heal to a thin line over months. Some people are prone to red and raised scars, which often continue to improve over six to eighteen months.
Any operation with general anaesthetic carries risks including heart problems, lung problems, blood clots, and drug reactions, though serious complications in healthy patients are extremely rare.
It is important that you tell surgeon and your anaesthetist about any medical conditions or medications prior to surgery.
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