Parathyroidectomy

What is a parathyroidectomy?

A parathyroidectomy is a surgical procedure to remove one or more of your parathyroid glands, which are four small glands located behind the thyroid in your neck. These glands produce parathyroid hormone (PTH), which regulates calcium levels in your blood.

If one or more parathyroid glands become overactive (hyperparathyroidism), they can cause dangerously high calcium levels, leading to bone loss, kidney stones, fatigue, and other health issues. Surgery is often the best treatment for long-term management.

Why might you need a parathyroidectomy?

Your doctor may recommend parathyroid surgery if you have:

• Primary hyperparathyroidism – An overactive parathyroid gland causing high calcium levels
• Parathyroid adenoma – A benign (non-cancerous) growth in one of the glands.
• Hypercalcaemia (high blood calcium levels) – Leading to symptoms like kidney stones, osteoporosis, muscle weakness, and fatigue
• Parathyroid cancer – A very rare condition requiring surgery
• Secondary or tertiary hyperparathyroidism – Often seen in patients with kidney disease

If left untreated, high calcium levels can cause long-term damage to your bones, kidneys, and cardiovascular system.

Types of parathyroidectomy

There are different types of parathyroid surgery depending on how many glands are affected:

• Minimally invasive parathyroidectomy (MIP) – The most common procedure, where only the affected gland is removed through a small incision
• Bilateral neck exploration – If multiple glands are affected, the surgeon may check all four glands and remove the diseased ones
• Subtotal parathyroidectomy – Part of the overactive gland is removed, often used in patients with kidney disease
• Total parathyroidectomy with auto transplantation – Rarely, all glands are removed, and some tissue is reimplanted in another part of the body (e.g., forearm)

Your surgeon will recommend the best approach based on your condition.

Preparing for parathyroid surgery

Before surgery, you may need:

·      Blood tests – To check calcium and PTH levels

·      Ultrasound scan – To locate the abnormal parathyroid gland(s)

·      Sestamibi scan – A special scan that highlights overactive parathyroid glands

·      CT or MRI scans – Used in some cases for more detailed imaging

Your consultant will provide instructions on medication adjustments and fasting before surgery.

What happens during a parathyroidectomy?

A parathyroidectomy is performed under general anaesthetic, meaning you will be asleep during the procedure.

·      A small incision is made in your neck

·      The surgeon identifies and removes the overactive parathyroid gland(s)

·      The incision is closed with dissolvable sutures or stitches

·      The procedure typically takes 30 minutes to 2 hours, depending on how many glands are removed.

Most patients go home the same day or after an overnight stay.

Risks and complications of parathyroidectomy

Parathyroid surgery is highly effective, but as with any surgery, there are some risks:

·      Temporary or permanent low calcium levels (hypocalcaemia) – Managed with supplements

·      Hoarseness or voice changes – Rare but possible if the vocal cord nerve is affected

·      Bleeding or infection – Uncommon, but possible risks after any surgery

·      Persistent hyperparathyroidism – If all overactive tissue is not removed, further surgery may be needed

Recovery after parathyroidectomy

You may experience:

• Mild neck discomfort – Improves within a few days.
• Temporary hoarseness – Due to minor nerve irritation.
• Low calcium levels (hypocalcaemia) – If multiple glands were removed, you may need calcium supplements.

When can you return to normal activities?

• Most people go home the same day or within 24 hours.
• Light activities can resume in a few days.
• Work and normal activities can usually be resumed in 1–2 weeks.
• Avoid heavy lifting or strenuous exercise for 2–4 weeks.

Your doctor will provide specific aftercare instructions, including wound care and follow-up blood tests.

Will I need medication after surgery?

• If only one parathyroid gland was removed, your remaining glands should regulate calcium normally
• If multiple glands were removed, you may need calcium and vitamin D supplements until your body adjusts
• Your doctor will monitor your calcium and PTH levels with blood tests

Success rates of parathyroidectomy

Parathyroidectomy is the gold standard treatment for overactive parathyroid glands and has a high success rate (over 95%) for curing primary hyperparathyroidism and reducing calcium levels.