The parathyroid glands are the smallest organ in the body and were the last to be discovered. There are 4 glands in the neck. They are usually located behind the thyroid gland (located in the middle and lower part of the neck), with two on the left and two on the right side, although their position can vary and occasionally, they are difficult to find as their normal size is only around two to three millimetres in size.
A Parathyroidectomy is usually performed for hyperparathyroidism (a condition where your parathyroid glands produce too much parathyroid hormone) which usually results in a high blood calcium level. High calcium levels can cause you to feel tired, develop kidney stones or suffer with muscle, bone or abdominal pains. Severely high calcium levels can cause serious complications which require urgent medical treatment and if your calcium is high, it should be monitored. There are a number of different types of hyperparathyroidism but the most common one is primary hyperparathyroidism.
Primary hyperparathyroidism is caused by the glands producing too much parathyroid hormone. The high parathyroid hormone levels lead to a high calcium from increased absorption of calcium from your intestines and kidneys. There is also an excessive breakdown and release of calcium from your bones which can lead to osteoporosis (reduction of the density of bones with a propensity for fractures). Approximately 80-90% of people with primary hyperparathyroidism have something called a parathyroid adenoma. These are benign (meaning they don’t spread) and are usually isolated but very occasionally you can have more than one. Sometimes it is caused by parathyroid hyperplasia (a mild enlargement of all 4 parathyroid glands) and very rarely it can be due to parathyroid cancer (less than 1%).
A medical team will usually investigate your high calcium levels with blood and urine tests but we can arrange these if required. If you are found to have primary hyperparathyroidism (with a high calcium and a high parathyroid hormone level and no other cause identified) you will be sent for some tests to look for the exact cause. Usually, you will receive a nuclear medicine scan (either a sestamibi scan or SPECT CT scan) where radioactive labelled tracer material is used to detect where the parathyroid adenoma is or if you have parathyroid hyperplasia. The nuclear medicine scan is usually combined with an ultrasound scan to provide dual localisation (where both scans are used to find the adenoma).
Depending on the cause of your primary hyperparathyroidism, you will be offered surgery. If an adenoma is suspected you will be offered a Parathyroidectomy where the suspected adenoma is identified and removed. If no adenoma is found or parathyroid hyperplasia is suspected, treatment is with an operation called a four gland exploration. This is where all the parathyroid glands are found. If one is suspected to be the cause it may be removed on its own or up to three and a half parathyroid glands may be removed to try and lower your calcium down to a normal level. Anyone suspected of parathyroid cancer will be referred to the East Kent thyroid and parathyroid multidisciplinary team meeting for discussion and treatment. The operation offered will be discussed in more detail at your consultation.
Parathyroid surgery is performed through a small horizontal incision at the front of the neck and will leave a small scar (this is usually about four to five centimetres and we try to hide this in a natural skin crease (see Figure 2). The operation time can vary between 30 minutes to 2 hours depending on how easily the swollen parathyroid (adenoma) is located. Other risks are rare but include post-operative bleeding or infection, on-going high calcium (if you have or develop a second adenoma or you have parathyroid hyperplasia), a sudden drop in calcium (this can be treated with calcium replacement and usually settles very quickly) and damage of the nerve to the voice box which can cause a change in your voice. You may have a small surgical drain in your neck after the procedure to collect any excess fluid but this can be removed shortly after the procedure (I try to avoid these where possible). You will be required to stay in hospital for one night after the operation to check your calcium levels are stable before you are discharged home.
Most patients are discharged the following day after the operation and arrangement for removal of any sutures or skin clips (if applicable) will be done in clinic either after 48 hours or 1 week after the procedure depending on the type of material used to close the incision.