Parathyroidectomy

Parathyroidectomy is the name given to the operation where one or more parathyroid glands are removed. Often two scans (an ultrasound scan and a sestamibi scan) are required to locate the abnormal parathyroid gland that is making too much parathyroid hormone. Sometimes a 4D CT scan and an MRI scan are also requested.

When to perform Parathyroidectomy?

There are guidelines on when to perform parathyroidectomy in patients with primary hyperparathyroidism who have no symptoms (see references below).

Surgery is recommended if one, or more, of the following is present:

  1. Serum calcium >0.25 mmol/L above the upper limit of normal
  2. Osteoporosis: T score of -2.5 or greater on DEXA scan
  3. Poor kidney function: GFR or creatinine clearance <60 mL/min
  4. Kidney stones
  5. High urinary calcium, >250 mg/day in women; >300 mg/day in men)
  6. Age <50 years

Patients with symptomatic hyperparathyroidism should consider surgery even if the above criteria for asymptomatic patients are not met.

Parathyroidectomy Operation

Parathyroidectomy is done under general anaesthesia (you are fast asleep) to ensure your comfort. A small incision is made in a skin crease in the lower part of the neck.  

The recurrent laryngeal nerve is monitored throughout your surgery. You will most likely spend one night in hospital, and you are advised to take one week off work to recover.

Dr Hall does two main types of parathyroidectomy depending on the clinical situation:

  1. Focused Parathyroidectomy. If the location of the abnormal parathyroid gland is discovered on scans done prior to surgery, Dr Hall finds the abnormal parathyroid gland in the location indicated by the scan and removes it. This is called a focused parathyroidectomy.
  2. Bilateral Neck Exploration. If the location of the abnormal parathyroid gland is not discovered on scans done prior to surgery, or you have tertiary hyperparathyroidism, Dr Hall will look at all four parathyroid glands during the operation. This is called bilateral neck exploration. If there are only one or two abnormal parathyroid glands, then Dr Hall will remove the abnormal parathyroid glands. If all four parathyroid glands are abnormal, then Dr Hall will remove three and one half (3.5) abnormal glands.

Following surgery, you will have two blood tests, one later the same day, and one the following morning.

The procedure has a high successful rate of 98% and patients usually feel a lot better immediately after their surgery. Complications are uncommon and include failure to fix the problem (1-2%), a calcium level that is too low (1%), bleeding (1%) and a hoarse voice from injury to the recurrent laryngeal nerve (1%). Dr. Hall will advise you the best course of action if this is the case.

Dr. Hall and Parathyroidectomy

Dr Hall has extensive experience with parathyroidectomy, treating both primary hyperparathyroidism and tertiary hyperparathyroidism. He always takes the utmost care when conducting surgery and ensures all his patients fully understand their treatment plan. He has presented his result on parathyroidectomy at the New Zealand Society of Otolaryngology Head and Neck Surgery annual scientific meeting in Queenstown in 2007.

References:

  1. Bilezikian JP, et al. Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop. J Bone and Mineral Research. 2022; 37: 2293-2314.
  2. Wilhelm SM, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016;151:959-968. 
  3. Weber T, et al. Management of primary and renal hyperparathyroidism: guidelines from the German Association of Endocrine Surgeons. Lagenbeck’s Archives of Surgery (2021) 406: 571-585.
  4. Pasieka JL, et al. The long-term benefit of parathyroidectomy in primary hyperparathyroidism: A 10 year prospective surgical outcome study. Surgery 2009;146:1006-13.
  5. Roman SA, et al. The Effects of Serum Calcium and Parathyroid Hormone Changes on Psychological and Cognitive Function in Patients Undergoing Parathyroidectomy for Primary Hyperparathyroidism. Ann Surg 2011; 253:131-137.
  6. Ye Z, et al. The efficacy and safety of medical and surgical therapy in patients with primary hyperparathyroidism: A systematic review and meta-analysis of randomised controlled trials. J Bone and Mineral Research. 2022; 37: 2351-2372.