Parathyroidectomy
Also known as: parathyroid gland removal surgery or simply parathyroid surgery
Parathyroidectomy is a surgery to remove one or more overactive parathyroid glands, usually to treat hyperparathyroidism caused by excess parathyroid hormone production.
What is a parathyroidectomy?
Parathyroidectomy is a surgery to remove one or more overactive parathyroid glands, usually to treat hyperparathyroidism caused by excess parathyroid hormone production.
The parathyroid glands play a vital role in maintaining calcium balance in the body, impacting nerves, muscles, and bone health. When these glands produce too much parathyroid hormone, it leads to elevated calcium levels in the blood, necessitating surgical intervention.
Generally, removing just one of the four parathyroid glands is sufficient. This method is often effective in addressing primary hyperparathyroidism by reducing the excessive levels of parathyroid hormone that cause elevated calcium in the blood. The goal of the surgery is to restore a healthier balance, providing patients with significant relief from the symptoms and complications of hyperparathyroidism.
Causes of overactive parathyroid glands
Overactive parathyroid glands, leading to conditions like primary hyperparathyroidism, are often caused by benign tumours or enlarged glands that do not respond to the body’s regulatory signals. Although rare, cancerous tumours can also be a cause. Primary hyperparathyroidism usually results from these benign abnormalities, but it can also be a genetic condition in some cases.
Secondary hyperparathyroidism is typically linked to chronic kidney disease, which disrupts the balance of calcium and phosphate in the body, leading to elevated parathyroid hormone levels.
Why you might need parathyroidectomy
The symptoms of hyperparathyroidism can be varied and sometimes vague, making diagnosis challenging. Common symptoms include:
- Fatigue
- Kidney stones
- Muscle pain due to elevated calcium levels
- Excessive thirst
- Frequent urination
These symptoms can often be misattributed to other conditions, delaying proper diagnosis and treatment.
Muscle weakness and constipation are additional signs of hyperparathyroidism that can affect overall well-being. Some individuals might experience mild confusion or depression, further complicating the identification of the underlying issue. When blood calcium levels rise significantly due to primary hyperparathyroidism, these symptoms often become more pronounced, leading to the need for surgical intervention.
Recognising these symptoms early and consulting with a healthcare provider can help in timely diagnosis and treatment. If you or a loved one are experiencing any of these symptoms, it may be worth discussing the possibility of hyperparathyroidism and the potential need for parathyroid surgery with your doctor.
Hospital fee guide price: £3,822
Procedure price subject to bespoke quotation
*Additional consultant fee not included
Before surgery
Initial consultation
During your consultation for a parathyroidectomy, your doctor will begin by reviewing your medical history and discussing your symptoms. They’ll likely perform a physical exam and may recommend blood tests or imaging scans to evaluate your parathyroid glands. If they suspect an issue, such as hyperparathyroidism, they will explain the benefits and risks of surgery to you. The doctor will answer any questions you have and guide you through the procedure, recovery process, and any necessary follow-up care, helping you feel informed and prepared for the surgery.
Preparing for parathyroid surgery
Preparing for parathyroid surgery involves several important steps to ensure the procedure goes smoothly. You need to be aware of necessary preparations, including dietary adjustments and specific instructions from healthcare providers. One of the most common guidelines is to refrain from eating or drinking after midnight before the surgery.
You are also advised to manage your medications carefully, especially if you are taking blood thinners. It’s important to avoid these medications for a specified period before the surgery to reduce the risk of excessive bleeding. Confirming these medication guidelines with your healthcare provider is essential to ensure a safe surgical experience.
Understanding these steps can help alleviate anxiety and ensure a successful outcome.
Pre-surgery tests
Before undergoing parathyroid surgery, several tests are conducted to assess your overall health and locate the overactive parathyroid glands. Routine blood tests are essential to evaluate hormone levels, including parathyroid hormone (PTH) levels. Imaging techniques such as ultrasound, X-rays, MRI, or radio-isotope scans are commonly used to pinpoint the precise location of the parathyroid glands. Additionally, a sestamibi scan can be particularly useful in identifying hyperactive glands.
In some cases, an ear, nose, and throat (ENT) surgeon may examine your vocal cords before surgery to ensure there are no complications that could affect your voice. These pre-surgery tests are crucial in planning the surgical approach and increasing the likelihood of a successful surgery.
During surgery
Parathyroidectomy is a technically challenging operation that requires the expertise of a specialist surgeon. The procedure typically involves making an incision in your neck to access and remove the overactive parathyroid glands.
There are different surgical approaches to parathyroidectomy, each with its own benefits and considerations. Minimally invasive techniques, which involve smaller incisions, are often preferred because they can lead to less scarring and a quicker recovery. Scarless parathyroid surgery, performed through an incision inside your mouth, is another option that leaves no visible scars.
Traditional parathyroid surgery involves a larger incision to remove the overactive glands. The choice of technique depends on various factors, including your specific condition and the surgeon’s expertise.
The duration of a parathyroidectomy typically ranges from one to two hours, depending on the complexity of the case. Parathyroid surgery is performed under general anaesthesia, ensuring that you remain pain-free and comfortable throughout the procedure. This also ensures that your vocal cords and other essential structures are protected during the surgery, reducing the risk of complications.
After surgery
Immediate post-surgery care
After parathyroid surgery, you can leave the hospital on the same day. However, immediate post-surgery care is crucial to ensure a smooth recovery. If you experience a sore throat, eating soft foods for a day or two can help alleviate discomfort. Temporary symptoms like hoarseness or a sore throat are common and usually resolve on their own.
It’s important to monitor for symptoms of low calcium, such as numbness or muscle cramps, and contact your surgeon immediately if they occur. You should avoid heavy lifting and strenuous activities until you receive clearance from your surgeon. Proper wound care is also essential; keeping Steri Strips dry for the first day and then washing gently with mild soap can help prevent infection.
Full recovery from parathyroidectomy typically ranges from one to three weeks, with most people able to resume normal activities within a few days. Having a friend or family member assist you during the initial recovery period can be beneficial.
Long-term recovery and aftercare
Long-term recovery after parathyroidectomy is essential as you adjust to changes in calcium levels. While the surgery often provides significant relief from symptoms, ongoing care is necessary to maintain optimal health.
Follow-up appointments
Regular follow-up appointments are crucial to assess calcium levels and ensure your remaining parathyroid glands are functioning properly after surgery. These visits help monitor recovery progress and catch any potential issues early. Typically, you should schedule a follow-up visit with your surgeon within three weeks to assess recovery progress. These check-ins are essential for long-term health and recovery.
Calcium and vitamin D supplements
After surgery, you are typically required to take calcium supplements and vitamin D tablets to maintain healthy calcium levels. Low blood calcium levels can occur post-surgery, making supplements necessary during the recovery period.
As your remaining parathyroid glands recover and start producing enough parathyroid hormone adequately, the need for calcium and vitamin D supplements may decrease.
Potential Complications
While parathyroid surgery is generally safe, there are potential complications to be aware of. Infection and haematomas are possible risks associated with the procedure.
Hungry bone syndrome, leading to long-term low calcium levels, can occur if your remaining parathyroid glands are damaged or absent. Transient changes in voice can also happen due to nerve identification challenges during surgery. Persistent high calcium levels can occur if a parathyroid gland was missed during surgery, requiring further intervention.
Recurrence and Further Surgery
Recurrence of hyperparathyroidism can occur in about 2.5% of patients after parathyroidectomy. Higher serum calcium and parathyroid hormone levels at six months post-surgery indicate an increased risk of recurrence. Conflicting results from preoperative imaging studies can also raise the likelihood of recurrence after surgery.
Continuous monitoring and follow-up can help manage and address any recurrence effectively.
Appointment and Treatment Plan
Appointment
Based on your previous consultation with a doctor, an appointment will be arranged between you and your surgeon.
Treatment plan
During this appointment, you will review your medical history, discuss the details of the surgery and recovery process, and collaboratively decide if this procedure is a suitable option for you.
Pre-op assessment
If surgery is an option, then the surgeon and their team will thoroughly assess whether you’re right for the surgery. They’ll consider your current health, any previous issues, and other external matters.
Surgery
Prior to going through with the surgery, our team will ensure that you’re prepped once again. If everything is confirmed, you’ll undergo the surgery and then we’ll explain the aftercare instructions.
Aftercare
If necessary, you’ll stay in a ward for a few hours to ensure that you’re ready to go home after the surgery. However, this may depend on the surgery outcome and whether you need moderate or light assistance.
Follow-Up
You’ll come in a few weeks later and we’ll give you one final check-over to ensure that you’re on track for recovery.
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Hospital fee guide price: £3,822
Procedure price subject to bespoke quotation
*Additional consultant fee not included
FAQs
After a parathyroidectomy, you may experience temporary changes to your voice, such as hoarseness, and potential low blood calcium levels that can usually be managed with supplements. These effects generally improve within the first month post-surgery.
Yes, a parathyroidectomy is considered a major surgery, but it is often performed as a minimally invasive procedure with the potential for significant benefits in treating hyperparathyroidism.
The main purpose of a parathyroidectomy is to remove one or more overactive parathyroid glands to treat hyperparathyroidism and restore normal calcium levels in the blood. This surgical intervention effectively alleviates symptoms and prevents complications associated with calcium imbalance.