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The parathyroid glands are located behind the thyroid gland in the neck.
The parathyroid glands are located behind the thyroid gland in the neck. There are four parathyroid glands in the body, and they produce parathyroid hormone (PTH). PTH regulates the body's calcium and phosphorus levels. Parathyroidectomy is the surgical removal of the parathyroid glands. This is done to remove a tumor of the parathyroid gland.
Because the surgery is usually done using the minimally invasive technique, the recovery time after parathyroidectomy surgery is relatively short.
Most patients can go home the same day or the next day after surgery. Patients can begin their daily activities in a few days. It can take up to 3 weeks to fully heal and recover. Most patients can return to work in 1-2 weeks. Patients commonly experience, pain, fatigue, sore throat, and generalized weakness, which usually resolves within 1-2 weeks. Painkillers are usually prescribed to manage postoperative pain.
After the parathyroidectomy, the calcium levels may drop below the normal levels, which can be dangerous to health. The patients would have to undergo routine blood tests to check calcium levels in the blood. The doctor may prescribe calcium supplementation if needed. Mild hypocalcemia (decreased calcium) is often asymptomatic. Patients may experience muscle weakness, twitching, spasms, cramps, and irritability, as well as pins and needles sensation.
Why is parathyroidectomy performed?
Parathyroidectomy may be done if one or more of the parathyroid glands produce too much parathyroid hormone (hyperparathyroidism). It is usually due to a small noncancerous (benign) tumor of the parathyroid called an adenoma (parathyroid adenoma). Not all adenomas require surgery. The decides to operate based on the patient’s age, calcium levels in the blood and urine, and presence of symptoms. Cancer of the parathyroid gland is extremely rare. Parathyroidectomy is required in the cases of cancer as well.
How is parathyroidectomy performed?
The surgery is performed under general anesthesia. A 2-4 inch (5-10 cm) surgical incision (cut) is made on the front of the neck, just below Adam’s apple along the neck crease line. The surgeon will look for the four parathyroid glands and remove the ones that are diseased. The location of the parathyroid is often unpredictable. All four of the glands may be removed in some cases. If all four of the glands need to be removed, a small piece of the healthy tissue from one of the glands is transplanted into the forearm muscle to help maintain the body's calcium levels. If the gland cannot be transplanted, patients may require lifelong calcium supplementation.
There are several less invasive surgical techniques for parathyroidectomy, which can be performed depending on the extent and location of the parathyroid disease. They cause less scarring, pain, and recovery time compared to traditional techniques. The surgical techniques include:
- Minimally invasive parathyroidectomy: The surgeon injects a small amount of radioactive tracer before surgery, which helps highlight the diseased glands. A special probe may then be used to locate the parathyroid gland. The surgeon makes a small incision of 1-2 inch on the side of the neck, to remove the diseased gland. The procedure takes about an hour.
- Video-assisted parathyroidectomy: The surgeon makes two small incisions in the neck. The camera is inserted through one incision and the surgical instruments are inserted through the other incision.
- Endoscopic parathyroidectomy: The surgeon makes two or three small incisions in the front of neck and one cut above the collarbone. Camera and surgical instruments are inserted through these incisions.
What are the complications of parathyroidectomy?
Risks may be associated with anesthesia, the surgical procedure, or the absence of the parathyroid gland. They include:
- Reactions to anesthesia or other medications used during surgery
- Bleeding
- Clots in the blood vessel
- Infection
- Injury to the thyroid gland
- Injury to surrounding nerves, blood vessels, and muscles that help the vocal cords move
- A temporary permanent change in voice
- Difficulty breathing
- Hypoparathyroidism: It is rare, but parathyroidectomy may cause a serious adverse event. It is due to a sudden drop in the parathyroid hormone levels following parathyroid removal, leading to decreased calcium levels. Such a steep drop may cause fatal heart rhythm abnormalities and even death.