Parathyroidectomy

Also known as "Parathyroid gland removal", Parathyroidectomy is the surgical removal of one or more parathyroid glands. This procedure is used to remove primary tumors or hyperplasia of the glands, especially when they produce excessive parathyroid hormone. As drugs such as Fosamax do not treat the underlying cause of parathyroid-related osteoporosis, surgery is the only cure. Bone loss is reversible.

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The location of the glands is generally behind the thyroid, but there is a lot of variation. Usually, the location of an enlarged gland has been confirmed via a sestamibi scan or on ultrasound.

Procedure

During the operation, the patient is usually put under a general anesthetic (unconscious and pain free) or a local anesthetic (pain free). The surgeon makes an incision around an inch long in the neck just under the Adam's apple and locates the offending parathyroid glands. Preoperative testing using [sestamibi] scanning can identify the location of glands. It can also be used to limit the extent of surgical exploration and facilitate a radioguided parathyroidectomy^[1].

The particular problem or disease will determine how many of the parathyroid glands are removed. Some parathyroid tissue must be left in place to help prevent hypoparathyroidism.

The patient usually recovers very quickly after the operation. The PTH level is back to normal within 10-15 minutes, and is confirmed by routine blood tests following the operation. However, the remaining parathyroid glands may take hours to several weeks to return to their normal functioning levels. Patients must be placed on calcium supplements to prevent symptoms of hypocalcemia.

References

• Lee, J.A. (2006-10-16). Parathyroidectomy. Medical Encyclopedia. Medline Plus. Retrieved on 2007-11-02.

• Nanka O, Sedý J, Vítková I, Libánský P, Adámek S (2006). "Surgical anatomy of parathyroid glands with emphasis on parathyroidectomy.". Prague Med Rep 107 (2): 261-72. PMID 17066745.

• Untch BR, et al (2007). "Minimally invasive radio-guided surgery for primary hyperparathyroidism.". Ann Surg Oncol. 14 (12): 3401-2. PMID 17899291.