Hyperparathyroidism, which is a condition that occurs when the parathyroid glands make too much parathyroid hormone (PTH), can lead to complications, including very high levels of calcium in the blood, kidney stones, and osteoporosis. If you have primary or tertiary hyperparathyroidism then surgery would be recommended – in cases where one or more of the parathyroid glands contain an adenoma, a benign tumor. The surgery is performed to remove the overactive parathyroid gland.
In most cases, only one parathyroid gland is overactive and needs to be removed. Identifying the abnormally functioning gland is essential before a surgery since the four parathyroid glands are small and close to one another.
There are tests which are done to assist your doctors in determining which parathyroid gland requires removal. Identifying this gland before surgery helps in ensuring that you, through your surgeon, have the right procedure by targeting the correct parathyroid.
A sestamibi is an imaging test that is used to detect overactive parathyroid glands. Before the scan, you are given an intravenous (IV) injection with a very small amount of radioactive material known as sestamibi. An overactive parathyroid gland would absorb this material quicker than a normally functioning gland does.
The scan’s results will show which gland or glands are abnormally functioning and guide your surgeon in performing the surgery.
An ultrasound exam of the neck helps to detect enlarged parathyroid glands. Together with the sestamibi scan, an ultrasound can be helpful in confirming the exact location of the overactive parathyroid glands. In addition to this, it can also reveal the presence of nodules on the thyroid – located in front of the parathyroid glands. Most individuals with parathyroid adenomas also have thyroid nodules. These thyroid nodules usually require evaluation prior to parathyroid surgery.
Advanced Parathyroid Imaging
In cases where the overactive parathyroid can’t be located using ultrasound imaging or sestamibi, a four-dimensional CT, called 4-D, may be required. The images can then be combined with additional sestamibi imaging, producing accurate maps of structures in the neck. The images reveal both the tumor location and tumor function as well.
A focused parathyroidectomy is performed only when one parathyroid gland is functioning abnormally and needs to be removed. The procedure requires general anesthesia. During the procedure, a small incision is made in the neck and relying on the information from the parathyroid adenoma imaging, the surgeon finds the affected parathyroid gland and removes it.
Surgeons try as much as they can to avoid injury to other nearby glands and nerves. Once the parathyroid gland is removed, the surgeon then closes the incision with dissolvable sutures.
During a focused parathyroidectomy, surgeons normally use a strategy known as intraoperative parathyroid hormone monitoring. The surgeon tests the parathyroid hormone levels in your blood before surgery and again at intervals after removing the overactive gland to see whether the hormone levels drop to the normal range.
The parathyroid hormone levels are very sensitive in that even within 10 minutes of removing the gland, the parathyroid hormone levels in the blood return to normal. Intraoperative parathyroid testing allows for confirmation that all overactive glands have been removed.
The parathyroid hormone levels rarely drop even after removing the targeted parathyroid gland. If this happens, your surgeon may investigate which of the other parathyroid glands is causing the abnormally elevated hormone levels. With the help of intraoperative parathyroid hormone testing and based on the appearance of the gland, additional glands that are functioning abnormally can be removed.
What to Expect After Surgery
Depending on your overall health and your doctor’s preference, you can be discharged the same day or the morning after surgery.
You may have slight discomfort and swelling in your neck after surgery. Taking pain medication and keeping your head elevated on a pillow can make you more comfortable. You may develop a sore throat, but it will subside in about two days; but if it persists, call your doctor.
Complications from parathyroidectomy are very rare, but they include bleeding, infection and injury to adjacent parathyroid glands or the recurrent laryngeal nerve, which can cause hoarseness or even the loss of your voice. In case you experience any the said side effects after surgery, tell your doctor immediately.
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