Parathyroidectomy
Parathyroidectomy is a surgical procedure aimed at treating hyperparathyroidism, a condition characterized by excessive secretion of parathyroid hormone (PTH) from the parathyroid glands located behind the thyroid gland in the neck. This overproduction of PTH can lead to elevated blood calcium levels, resulting in various complications such as bone demineralization, skeletal pain, muscle weakness, and increased kidney damage. Symptoms can vary, with some patients being asymptomatic, while others may experience severe complications that necessitate surgical intervention.
During parathyroidectomy, the surgeon typically removes the affected parathyroid tissue, which may involve excising three of the four glands if hyperplasia is present, or removing a benign tumor if one is found. Post-surgery, patients are monitored for levels of calcium and PTH, as rapid changes can lead to complications like transient muscle contractions. While recovery generally aligns with other surgical procedures, there are risks, including potential injury to nearby structures such as the thyroid gland and vocal cords. In cases where PTH levels become too low post-operation, long-term supplementation with calcium and vitamin D may be required. This procedure is essential for restoring hormonal balance and alleviating symptoms associated with hyperparathyroidism.
Parathyroidectomy
Anatomy or system affected: Endocrine system, glands, neck
Definition: The removal of all or part of the parathyroid gland or parathyroid tumors
Indications and Procedures
The parathyroid glands are four structures attached to the rear of the thyroid gland, which is found in the neck. Their main function is the secretion of parathyroid hormone (PTH), a protein that regulates the concentration of blood calcium. Abnormalities in proper calcium concentration can lead to bone demineralization, neuromuscular problems, or renal (kidney) damage.
Parathyroidectomy is occasionally warranted under conditions of hyperparathyroidism: the excess secretion of PTH. Hyperparathyroidism most commonly results in excess resorption of bone calcium, causing skeletal pain or loss of height. The demineralization may also lead to fractures of the spine or long bones, which may be accompanied by extreme muscle weakness and frequent urination. Since the patient may be asymptomatic, diagnosis is most commonly made on the determination of excess serum and urine calcium. X-rays may also indicate bone abnormalities resulting from the resorption of calcium. The condition itself may be caused by hyperplastic (overactive or enlarged) glands, or in less common circumstances (2 percent of cases), hyperparathyroidism may result from a parathyroid adenoma (a benign tumor on a gland).
Asymptomatic patients, or patients with only mildly elevated blood calcium, may not need treatment. Should symptoms become more severe, surgical procedures may be necessary, generally involving the removal of excess parathyroid tissue. If the hyperplasia involves all four parathyroid glands, three of the glands are usually removed, with resection of the fourth. If the cause of the PTH elevation is an adenoma, it is necessary to remove the tumor surgically.
Uses and Complications
Since the primary symptom of hyperparathyroidism is excess blood calcium, the removal of excess tissue may suddenly reduce calcium levels to normal. The rapid fall of calcium may cause transient tetany (involuntary muscle contractions), but otherwise, recovery from such surgery parallels any other surgical procedure. PTH and calcium levels must continue to be monitored postoperatively. If parathyroidectomy results in excessively low PTH levels, it may be necessary to provide lifelong diet supplements of calcium and vitamin D. Surgical complications include injury to the thyroid gland and/or to the vocal cords.
Bibliography
Braverman, Lewis E., ed. Diseases of the Thyroid. 2d ed. Totowa, N.J.: Humana Press, 2003.
Gardner, David G., and Dolores Shoback, eds. Greenspan’s Basic and Clinical Endocrinology. 9th ed. New York: McGraw-Hill, 2011.
Melmed, Schlomo, et al., eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia: Saunders/Elsevier, 2011.
Montemayor-Quellenberg, Marjorie. "Parathyroidectomy—Conventional." Health Library, June 13, 2013.
Montemayor-Quellenberg, Marjorie. "Parathyroidectomy—Minimally Invasive." Health Library, June 13, 2013.
Neal, J. Matthew. Basic Endocrinology: An Interactive Approach. Malden, Mass.: Blackwell Science, 2000.
"Parathyroid Gland Removal." MedlinePlus, 22 Aug. 2022, medlineplus.gov/ency/article/002931.htm. Accessed 20 July 2023.
Rosenthal, M. Sara. The Thyroid Sourcebook. 5th ed. New York: McGraw-Hill, 2009.
Ruggieri, Paul, and Scott Isaacs. A Simple Guide to Thyroid Disorders: From Diagnosis to Treatment. Omaha, Nebr.: Addicus Books, 2004.