General Surgery

Parathyroidectomy Treatment

Parathyroidectomy

Parathyroidectomy is the surgical procedure for removing one or more parathyroid glands. This procedure is used for removing primary tumors or hyperplasia of the glands, particularly when they produce excessive parathyroid hormone (hyperparathyroidism).

What is Parathyroidectomy?

Parathyroidectomy is the surgical procedure for removing one or more parathyroid glands. This procedure is used for removing primary tumors or hyperplasia of the glands, particularly when they produce excessive parathyroid hormone (hyperparathyroidism). The location of the glands is generally behind the thyroid, but there can be a lot of variation. Generally, the location of an enlarged gland has been confirmed by an ultrasound or a sestamibi scan.

What are the risks involved?

Hoarseness (i.e. recurrent laryngeal nerve injury): The recurrent laryngeal nerves lie on either side of the trachea (windpipe) right in the site where the parathyroid glands are found. These recurrent laryngeal nerves control the vocal cords of an individual. Injury to one of the nerves may lead to hoarseness or a whispering quality to the voice of the patients. Sometimes, the nerve becomes irritated while removing the parathyroid gland and ultimately leads to temporary hoarseness.

Low calcium levels in the blood (i.e. hypocalcemia or hypoparathyroidism): Low calcium levels in the blood can result after the parathyroidectomy because either the remaining parathyroid glands are stunned after the surgery or too much parathyroid tissue was being removed.

Wound infection: Infections in the neck after the operation are very rare and may only occur once in every 1,000 patients. For this reason, antibiotics are usually not needed before or after the operation. If a redness, fever, or swelling of the wound develops, the patient should be visited by the surgical team for further evaluation.

What does the procedure involve?

The patients will receive general anesthesia for this surgery.Page Image

Generally, the parathyroid glands are being removed by the use of a two to four inch surgical cut on the neck.

During surgery:

The incision is generally made in the center of the neck, just under the patient’s Adam's apple.

The surgeon will look for the four parathyroid glands and will remove any of the glands that are being diseased.

The patients may require a special blood test during surgery to tell if all the diseased glands were removed or not.

In very rare cases, when all four glands are required to be removed, part of one is being transplanted into the forearm. Or, it is being transplanted into a muscle in the front of the neck just next to the thyroid gland. This helps ensure the patient’s body's calcium level stays at a healthy level.

The specific type of surgery required by the patients depends on where the diseased parathyroid glands are present. Types of surgery include the following:

Minimally invasive parathyroidectomy: The patients may receive a shot of a very small amount of radioactive tracer before they have undergone this surgery. This is useful in highlighting the diseased glands. If the patients have this shot, the surgeon will use a special probe, like a Geiger counter, for locating the parathyroid gland. The surgeon will make a small incision on one side of the patient’s neck, and then the diseased gland is being removed through it. This surgical procedure usually takes about 1 hour.

Video-assisted parathyroidectomy: The surgeon will make two small incisions in their neck. One incision is for instruments, and the other is for a camera. The surgeon will use the camera to see the site and the diseased glands will be removed with the help of these instruments.

Endoscopic parathyroidectomy: The surgeon will make two or three small incisions in the front of the patient’s neck and one cut above the top of the collarbone. This reduces visible scarring, recovery time and pain. This incision is less than 2 inches long. The procedure for removing any diseased parathyroid glands is quite similar to that of video-assisted parathyroidectomy.

After the Surgery:

Usually, people can go home the same day as they have surgery. The patients can start their day to day activities in a few days. It usually takes about 3 weeks for them to fully heal. The surgical site must be kept clean and dry. The patients may be required to drink liquids and eat soft foods for a day or so. The patients must call their surgeon if they have any tingling or numbness around their mouth in the first 24 to 48 hours after the surgery. This can result as a result of low calcium. After this surgical procedure, the patients should have routine blood tests for checking their calcium level. People generally recover soon after this operation. Parathyroid glands are very small; the patients may be required to have tests that show exactly where the glands are. This will help the surgeon find the patient’s parathyroid glands during surgery. Two of the tests the patients may have are an ultrasound and a CT scan. Before surgery, an anesthesiologist (is a doctor who will give the patients medicine that allows them to sleep and be pain-free during surgery and monitors the patients during surgery) will review the patient’s medical history and decide what type of anesthesia is preferable to them.

The patients must tell their surgeon:

  • If the patients are or might be pregnant
  • What vitamins, herbs, medicines, and other supplements the patients are taking, even ones the patients bought with them without a prescription

During the week before your surgery:

  • The patients must fill any prescriptions for pain medicine and calcium that they will require after the surgery.
  • The patients may be asked to stop taking blood thinners. These include vitamin E, warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), clopidegrel (Plavix), and NSAIDs (aspirin, ibuprofen),
  • The patients must ask their surgeon, which drugs they should still take on the day of their surgery.

On the day of the surgery:

  • The patients must follow instructions about what to eat and drink.
  • The patients must take the medicines the surgeon asked them to take with a small sip of water.
  • The patients must arrive at the hospital at the time.
  • Hniques are used.
  • Sometimes, another surgery may be required for removing more of the parathyroid glands.

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