Parathyroid Surgery
Parathyroid Surgery: The parathyroid glands are located in the neck, closely related to the Thyroid gland. There are usually 4 glands in total (two on each side of the neck). Parathyroid disease usually results from hyperfunction of one or more glands.
Normal glands are quite small about 5-7mm in size. The glands are important for controlling calcium levels in the body.
The most common cause of hyperparathyroidism is increased growth of a single gland (adenoma). This is Primary Hyperparathyroidism. The enlargement of the gland causes excessive calcium levels in the blood which may result in multiple medical problems including kidney stones and osteoporosis.
Less common causes of Primary Hyperparathyroidism are –
Hyperplasia of multiple parathyroid glands
Multiple adenoma
Cancer
There are also Secondary and Tertiary Hyperparathyroidism conditions which are related to renal failure. These conditions can also require surgical removal of the parathyroid glands.
Diagnosis
Hyperparathyroidism is often diagnosed after a blood test revealing high calcium levels.
Dr Geere may also arrange further blood and urine tests for you to confirm the diagnosis.
Also further imaging is required which may include an Ultrasound scan of the neck to locate an enlarged parathyroid gland. Also a Nuclear Medicine Sestamibi scan may be required to localise the hyperfunctioning gland.
There is also the potential for a specialised 4DCT scan of the neck to localise a Parathyroid gland, this is especially used to aid in re-operative surgery.
Surgery for Parathyroidectomy
Surgery is undertaken under a general anaesthetic.
Most patients are required to stay 1 night. A blood test will be taken the following morning to check the calcium and parathyroid hormone levels.
Minimally Invasive Parathyroidectomy
As most cases of Primary hyperparathyroidism will be a single adenoma (enlarged gland) Dr Geere is happy to offer minimally invasive surgery to patients who have had the hyperfunctioning gland identified on imaging. This requires only a small 1-2cm incision at the neck to allow removal of the enlarged gland. On it’s removal the gland will be tested by a pathologist to confirm hyperactive parathyroid tissue.
4 gland Parathyroid exploration
If the enlarged Parathyroid is unable to be located on imaging studies, or when multiple glands are involved a formal 4 gland exploration is required to identify all 4 parathyroid glands and remove those that are enlarged. This requires a skin crease incision at the neck, usually 4-6cm in length. Dissection around the thyroid is performed to identify the parathyroid glands. Enlarged glands will be excised and tested by a pathologist to confirm hyperactive parathyroid tissue. Small normal glands may be biopsied also to confirm the location of the gland for future reference (especially in cases of hyperplasia).
Potential Risks and Complications
During your surgical consultation Dr Geere will discuss your surgical plan.
Particular attention is made during the operation to identify and preserve the Recurrent Laryngeal Nerve.
It can occasionally occur that not all 4 glands may be identified as the Parathyroid glands may have aberrant anatomy. If this is the case you will be closely monitored post-operatively to diagnose any ongoing elevated calcium levels. Further specialised imaging may be required to locate ectopic parathyroid glands (ie. Glands located in the chest).
Low calcium levels can sometimes be experienced post-op. This is usually temporary as the remaining Parathyroid glands readjust the body’s calcium level back to normal.