Definition and Overview
Parathyroidectomy is a medical surgical procedure that refers to the partial or complete removal of the parathyroid gland or parathyroid tumours. The parathyroid glands, which help control the calcium level in the blood, are located right behind the thyroid gland in the neck. In the past, excising the parathyroid glands was challenging because of their location. However, advances in the field of medicine have made this procedure easier and safer. In fact, in the majority of cases, it is performed on an outpatient basis with patients enjoying faster recovery time and better prognosis.
is a complete or partial parathyroid gland removal. The procedure may be invasive or minimally invasive.
A typical person can have two pairs of parathyroid glands, which sit behind the thyroid glands. Although both are part of the endocrine system, they have different unique characteristics. For example, the parathyroid glands are smooth while the thyroid glands are lobular. However, because of the location of the parathyroid, surgery for their excision remains to be challenging.
Fortunately, technologies have caught up that the procedure can already be done in an outpatient setting with a faster recovery and better prognosis.
Who Should Undergo and Expected Results
One of the foremost reasons for the complete or partial parathyroid gland removal is hyperparathyroidism, a condition wherein the glands produce too much of its hormones leading to . This can be indicated by an abnormally high level of calcium level in the bloodstream.
The main causes of Many reasons can cause hhyperparathyroidism are adenomas or benign tumours that grow in the parathyroid glands and exposure to strong radiation around the neck area. The presence of tumours causes the gland to expand leading to an excessive secretion of parathyroid hormone or PTH. Although it is possible for patients to have bilateral adenomas (which means that both glands have abnormal growths), in the majority of cases, only one gland is affected. In cases wherein both the glands are affected and therefore have to be removed, one is placed in the arm so the body will still have the ability to maintain ideal calcium level. . These include exposure to strong radiation around the neck area. Risk factors can also include age and gender. However, more than 80% of the cases are caused by adenomas or benign tumors that can grow in the glands. Risk factors can also include age and gender. If there’s a tumor growing, it causes the glands to grow and secrete excessive PTH. Studies point that while it’s possible to have bilateral adenomas (tumors found in two of the parathyroid glands), one affected gland is more common. If all the glands have to be removed, one of them will be placed in the arm in order to help maintain the ideal calcium level.
The tumor may also be malignant, but compared to other head and neck cancers, parathyroid cancer is extremely rare.
Hyperparathyroidism may also be described as secondary, which means it can be induced when a patient has a severe kidney disease or is undergoing kidney failure, vitamin D deficiency, and malabsorption, which may usually indicate gastrointestinal problems.
Once the tumor has already been removed, the patient may be able to bring PTH down and improve hormone balance. However, it’s still possible for the tumours to come back. It also doesn’t resolve the problem if the cause is an underlying condition like a kidney disease.
In some cases, when hyperparathyroidism is only mild, the endocrinologist may prefer to treat it with medications, supplement, or a change in diet before surgery is being considered.
How Does the Procedure Work?
Due to the location of the parathyroid glands and therefore the tumor, it’s standard for the surgeon to request for an imaging test like an X-ray or an MRI. The result can also be a basis on how the tumor will be removed.
The procedure may be done in an outpatient basis in a hospital. The patient lies in supine position with the neck fully exposed. The rest of the body and face will be covered by a sterile drape. General anesthesia is then applied.
If the surgery is invasive, the surgeon makes one long horizontal incision of at least 2 inches in length beneath the Adam’s apple. Clamps may be used to keep the incision open. The surgeon then looks for the parathyroid glands and using instruments like cautery the glands with the tumor is removed. The incision is then sutured and the area is dressed.
If it’s minimally invasive or limited approach, the surgeon may make at least three very small incisions to insert an endoscope and surgical tools (endoscopic) or two small incisions to introduce a video camera to help locate the glands. Tracers can also be used. The radioactive substance is absorbed by the parathyroid, which makes it respond to a special instrument that helps locate the tracer. An incision is made on the part of the neck where the diseased gland is found.
The procedure may take around an hour, depending on the complexity of the surgery. The patient normally can go home right after, but the recovery may take a few days to almost a month.
Possible Risks and Complications
In a complete or partial parathyroid gland removal, the patient is susceptible to infection, pain, and bleeding. He may also develop breathing problems or blood clots. Because of the nearness of the parathyroid to the thyroid gland, it’s possible that the latter may be injured or damaged, which can cause more hormonal problems. The surgery may also damage the vocal cords.