Parathyroid Procedures
What is the Parathyroid?
The parathyroid glands are tiny glands located within the neck that sit in very close relation to the thyroid gland. They produce parathyroid hormone (PTH), which plays a critical role in regulating calcium levels in the blood.
Hyperparathyroidism is a condition where too much PTH is produced. This hormone leads to the release of the body’s stores of calcium from the bones. This can cause high levels of calcium in the blood and weak bones (osteoporosis). The excess calcium in the blood must be filtered out by the kidneys and can put you at higher risk of kidney stones and kidney failure. Hyperparathyroidism can cause symptoms of lethargy, brain fog, bone ache, and low mood. While medications can be prescribed to lower blood calcium levels, the only way to eliminate the complications of hyperparathyroidism is with surgery.
Types of Parathyroid Surgery performed by Dr Hii
Neck Exploration and Parathyroidectomy
This surgery is the traditional approach to curing hyperparathyroidism. During surgery, all four parathyroids are identified and the abnormal gland, or glands, are removed.
The main time to perform neck exploration instead of minimally invasive surgery is when the pre-operative imaging cannot tell us which of the parathyroid glands is abnormal. This can be for a number of factors, one of which is that in a small number of patients (about 5%), more than one parathyroid gland is over producing PTH. In this case, the highest chance of a cure is to examine all of the parathyroids during surgery.
Parathyroidectomy is performed under general anaesthesia through a small incision in the neck. Patients are monitored in hospital over night and PTH and calcium levels are checked after surgery. It is unusual to need regular calcium tablets after surgery.
Minimally Invasive Parathyroidectomy
The diagnosis of hyperparathyroidism is made on blood and urine testing. However, once the diagnosis is made, imaging studies like ultrasound, sestamibi scans or CT scans can be used to locate the overactive parathyroid gland(s). If these studies locate a single, overactive gland, minimally invasive parathyroidectomy can be performed.
Minimally invasive parathyroidectomy targets a particular gland through a smaller incision than traditional parathyroidectomy. Surgery is performed under general anaesthesia and patients are monitored in hospital overnight. PTH and calcium levels are checked after surgery. It is unusual to need regular calcium tablets after surgery.
Subtotal and Total Parathyroidectomy
In rare cases, hyperparathyroidism is due to overactivity of all four glands. This is often due to another disease process, most commonly sever kidney failure. In this case, almost all (or occasionally all) parathyroid tissue must be removed to cure the hyperparathyroidism.
Subtotal parathyroidectomy is performed under general anaesthesia through an incision in the neck. A drip is inserted into a neck vein while you are under anaesthetic so that calcium levels can be monitored closely and IV calcium given if necessary. Patients usually stay in hospital until their calcium level is stable (usually 2 - 5 days).
DR BELINDA HII | MELBOURNE ENDOCRINE SURGEON
Providing personalised, specialist surgical care for diseases of the adrenal, thyroid and parathyroid glands.