Parathyroidectomy is the surgical removal of one or more parathyroid glands. This procedure is used to remove primary tumors or hyperplasia of the glands, especially when they produce excessive parathyroid hormone. As drugs such as Fosamax do not treat the underlying cause of parathyroid-related osteoporosis, surgery is the only cure. Bone loss is reversible.
The location of the glands is generally behind the thyroid, but there is a lot of variation. Usually, the location of an enlarged gland has been confirmed via 4D CT scan, a sestamibi scan or on ultrasound.
During the operation, the patient is usually put under a general anesthetic (unconscious and pain free) or a local anesthetic (pain free). The surgeon makes a midline incision around an inch long in the neck just under the Adam’s apple and locates the offending parathyroid glands. Preoperative testing using sestamibi scanning can help identify the location of glands. It can also be used to limit the extent of surgical exploration when used in conjunction with intraoperative PTH hormone monitoring or radio probe. The particular problem or disease process will determine how many of the parathyroid glands are removed. Some parathyroid tissue must be left in place to help prevent hypoparathyroidism
The patient usually recovers very quickly after the operation. The PTH level is back to normal within 10–15 minutes, and is confirmed by intraoperative rapid assessment during the operation. However, the remaining parathyroid glands may take hours to several weeks to return to their normal functioning levels. Patients must be placed on calcium supplements to prevent symptoms of hypocalcemia and to restore lost bone mass.