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 some tests which are done to assist your doctors in determining which parathyroid gland requires removal. Identifying this gland before surgery helps in ensuring that your surgeon can perform a minimally invasive procedure.
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 scan, 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.
If you have a condition known as parathyroid hyperplasia, in which multiple parathyroid glands are overactive, your surgeon may perform a subtotal parathyroidectomy.
In this procedure, the surgeon will remove three and a half of the four parathyroid glands. Generally, when all four glands are overactive, only half of one gland is left in the body. The half gland that is left is capable of producing an appropriate amount of parathyroid hormone for the body.
This procedure requires general anesthesia. During the procedure, your surgeon makes a small incision in your neck, then locates and removes the parathyroid glands one by one, leaving only the correct amount of parathyroid tissue in the neck. Your surgeon will use intraoperative parathyroid hormone testing to make sure that the levels fall into the correct range.
Surgeons try as much as possible to avoid injury to other nearby glands and nerves. After the surgeon removes the three and a half parathyroid glands, the incisions in the neck are closed with dissolvable sutures.
Sometimes, too much of the parathyroid gland is removed and this will leave you with hypoparathyroidism, or too little production of the parathyroid hormone. If this occurs, you will be prescribed calcium and activated vitamin D supplements to help regulate the levels of calcium in your body. This will compensate for the decreased production of parathyroid hormone.
For individuals who undergo subtotal parathyroidectomy for parathyroid hyperplasia, a portion of the removed parathyroid tissue can be frozen and stored, or cryopreserved. This tissue may later be re-implanted as a treatment, if need be, for postoperative hypoparathyroidism.
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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