Parathyroid gland removal

• Alternative Names

  Removal of parathyroid gland; Parathyroidectomy

• Description

  You will probably receive general anesthesia (asleep and pain-free) for this surgery. Or you may receive local anesthesia and medicine to relax you. You will be awake but pain-free.

  Usually the parathyroid glands are removed in open surgery, through a large incision (cut).

  • Your surgeon will make a 4 - 6 inch incision in your neck just under your Adam's apple.
  • Your surgeon will find the 4 parathyroid glands and remove any that are diseased.
  • You may have a special blood test during surgery that will tell if all the diseased glands were removed.

  Your surgeon may use 1 of these 3 other surgery techniques. Your surgeon must know where any diseased parathyroid glands are before using any of these techniques.

  • Minimally invasive parathyroidectomy: You may receive a shot of nuclear material before this surgery. If you have this shot, your surgeon will use a special probe, similar to a Geiger counter, to locate the parathyroid gland. Your surgeon will make a small cut (1 to 2 inches) on one side of your neck, and then remove the diseased gland through it. This procedure takes about 1 hour.
  • Video-assisted parathyroidectomy: Your surgeon will make two small cut in your neck. One is for instruments, and the other is for a camera. Your surgeon will use the camera to see the area and will remove the diseased glands with the instruments.
  • Endoscopic parathyroidectomy: Your surgeon will make two or three small incisions in the front of your neck and one cut above the top of your breastbone. A newer technique makes this third cut under your arm. This reduces visible scarring, pain, and recovery time. This cut is less than 2 inches long. The procedure to remove any diseased parathyroid glands is similar to video-assisted parathyroidectomy.
• Why the Procedure Is Performed

  Your doctor may recommend parathyroidectomy if one or more of your parathyroid glands is producing too much parathyroid hormone. This condition is called hyperparathyroidism. It is often caused by a small benign (non-cancerous) tumor called an adenoma.

  Your doctor will consider many factors when deciding whether to do surgery and what type of surgery would be best for you. Some of these factors are your age, calcium levels in your urine and blood, and whether you have thin bones (osteoporosis).

• Risks

  Risks for any anesthesia are:

  • Reactions to medicines
  • Breathing problems

  Risks for any surgery are:

  • Bleeding
  • Infection

  Risks for parathyroidectomy are:

  • Injury to the thyroid gland or the need to remove part of the thyroid gland
  • Hypoparathyroidism. This can lead to low calcium levels that are dangerous to your health.
  • Injury to the nerves in your vocal cord. You may have a weaker voice or a hard time swallowing thin liquids.
  • Difficulty breathing. This is very rare and almost always goes away several weeks or months after surgery.
• Before the Procedure

  Parathyroid glands are very small. You may need to have tests that show exactly where your glands are. This will help your surgeon find your parathyroid glands during surgery. Two of the tests you may have are a CT scan and an ultrasound.

  Before surgery, an anesthesiologist will review your medical history with you and decide what type of anesthesia to use. The anesthesiologist is the doctor who will give you the medicine that makes you asleep and pain-free during surgery and who monitors you during surgery.

  Fill any prescriptions for pain medicine and calcium you will need after surgery.

  Several days to a week before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), naproxen (Aleve, Naprosyn), and other drugs like these.

  You will probably be asked to stop eating or drinking at least 6 hours before surgery.

  Ask your doctor which medicines you should still take the day of surgery.

  If you smoke, try to stop. Your recovery time will be shorter if you do not smoke. Ask your doctor or nurse for help.

  Your doctor or nurse will tell you when to arrive at the hospital.

• After the Procedure

  Many times, people can go home the same day they have surgery. You can start your everyday activities in a few days. It will take about 1 to 3 weeks for you to fully heal.

  After this procedure, you should have routine blood tests to check your calcium level.

• Outlook (Prognosis)

  People usually recovery very quickly after this surgery. Recovery is fastest when less invasive techniques are used.

  Sometimes, another surgery is needed to remove more of the parathyroid glands.

• References

  Sosa JA, Udelsman R. The parathyroid glands. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 37.

Review Date: 1/30/2009

Reviewed By: Robert A. Cowles, MD, Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.