Parathyroid surgery

Tumours of the parathyroid gland are usually benign. However, as they lead to hyperfunction of the parathyroid glands, they must often be surgically removed. Depending on the disease, either parts of the parathyroid gland or the entire parathyroid gland itself will be removed. In certain cases, autotransplantation of the parathyroid gland is necessary.

As the name suggests, the parathyroid gland is situated near the thyroid. It produces the parathyroid hormone, which directs the metabolisation of calcium in the body. If a patient has a tumour in the parathyroid gland, i.e. a parathyroid adenoma, this causes increased activity in the parathyroid gland (hyperparathyroidism) and leads to an increase in the level of calcium in the body (hypercalcaemia), which produces different symptoms such as kidney stones, tiredness, muscle weakness and constipation. A parathyroid adenoma must therefore usually be removed surgically.

Another cause of hyperparathyroidism is chronic renal disease. Chronic renal insufficiency leads to metabolic disorders in the bones, which in turn stimulates production of the parathyroid hormone. The parathyroid must sometimes also be removed in such cases.

What preparations are carried out before the procedure?

The exact position and the spread of the parathyroid adenoma are determined before the surgery, and ultrasound examinations and a scintigraphy are also carried out. In addition, the parathyroid hormone is also measured and the kidney function is checked.

As is standard before all operations, all blood-thinning medication must be continued before the surgery. The operation is performed under general anaesthetic. Patients should therefore have an empty stomach for the procedure.

How is the operation performed?

The parathyroid gland consists of four parathyroid bodies which are attached to the thyroid glands. In general, only one parathyroid body is affected by a tumour.

The affected parathyroid gland is gently exposed with an incision under the larynx. Particular care must be taken with the vocal cord nerve which runs through the thyroid. If a patient has a parathyroid adenoma, only the parathyroid body affected by the tumour will be removed. The other three can be left in the body.

If the entire parathyroid gland is removed, a piece of the parathyroid gland will sometimes be transplanted, e.g. into the underarm. This procedure is known as autotransplantation. It guarantees that the parathyroid hormone will continue to be produced in the body.

 

What is the success rate of this procedure?

If the tissue affected by the tumour is removed, the hyperparathyroidism can usually be remedied. Any existing renal disease will not be affected by the surgery.

What are the possible complications and risks of this procedure?

As with all surgery, the operation may occasionally lead to infections, nerve damage, post-operative haemorrhaging or blood clots. There is an increased risk of injury to the vocal cord nerve which runs through the thyroid gland.  

What happens after the operation?

The vocal cords will be checked immediately after the operation. Patients can usually leave hospital in two or three days. The blood calcium level and the parathyroid hormone will be determined before the patient is discharged from hospital. If her or she has an overly low level of calcium, replacement therapy with calcium is sometimes necessary. People who have undergone this operation should avoid major physical exertion in the first two weeks after the operation.

In rare cases, the tumour will be a malignant carcinoma rather than a benign adenoma. In such cases, a further round of radiotherapy will usually be carried out after the parathyroid gland has been removed.

Centres (1)