Parathyroid Gland Removal (Parathyroidectomy)

What is a parathyroidectomy?

A parathyroidectomy is surgery to remove part or all of your parathyroid glands.

Usually you have 4 parathyroid glands in your neck. They make parathyroid hormone (PTH), which helps control the levels of calcium and phosphorus in the blood. Abnormal growth or overactivity of these glands may increase the amount of parathyroid hormone in your body. An increase in the hormone level can change the amount of calcium and phosphorus in your body. As a result, your bones may get weak. You may also have kidney stones, weakness in your muscles, decreased alertness, depression, or stomach pain. Removal of the overactive gland(s) can help stop these problems.

When is it used?

Your healthcare provider may recommend removing part or all of your parathyroid glands if:

• You have abnormal growth of some or all of the glands.
• One or more of the glands are overactive.

If your glands are only mildly overactive and you don’t have any symptoms, your healthcare provider may recommend that you have surgery only if you start having problems.

You may choose not to have treatment. Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.
• Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• You may or may not need to take your regular medicines the day of the procedure, depending on what they are and when you need to take them. Tell your healthcare provider about all medicines and supplements that you take.
• Your provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Follow any other instructions your healthcare provider gives you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do.

What happens during the procedure?

This procedure will be done at the hospital.

You will probably be given general anesthesia to keep you from feeling pain during the procedure. General anesthesia relaxes your muscles and you will be asleep.

A nuclear scan is done in the X-ray department about 2 hours before the operation. If an abnormal gland is found with the scan, your healthcare provider will make a small cut and remove the abnormal gland. Your provider will then close the cut. This procedure is called a minimally invasive parathyroidectomy.

If no site can be identified by the scan, your provider will make a larger cut in your neck and remove glands or parts of glands that appear abnormal. He or she will then sew the cut closed.

Sometimes all of the glands are overactive. In this case about three and a half of the four glands may be removed. Or your healthcare provider may remove all of the glands and put very tiny pieces of one of the glands in your arm so that you keep having some parathyroid function. A small metal clip is put in the same area so your provider can find the pieces of gland if the gland tissue becomes overactive again and needs treatment.

The procedure may take one to several hours, depending on how hard it is for your provider to find the parathyroid glands.

What happens after the procedure?

If you have just a small cut, you may be able to go home the same day. If you have a larger cut, you may be in the hospital for about 1 or 2 days, depending on your condition.

You may have some swelling in your neck and find that you have a sore throat and slight hoarseness. Your neck may tire out very easily for awhile, making it hard to hold up your head. You may need to take calcium to avoid having spasms in the muscles. You will have a scar in the front of your neck just above the breast bone.

Ask your healthcare provider:

• how long it will take to recover
• what activities you should avoid and when you can return to your normal activities
• how to take care of yourself at home
• what symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. Some possible risks include:

• Anesthesia has some risks. Discuss these risks with your healthcare provider.
• The nerves that control your speech may be injured. Damage to the nerves could make your voice hoarse. The damage may be temporary or lifelong.
• Rarely, the gland is in an abnormal position and cannot be found. Your healthcare provider will need to look for it during the procedure.
• You may have infection or bleeding.
• You may have weakness and muscle cramps because your blood doesn’t have enough calcium. If this happens, you will be given calcium to relieve the symptoms.

There is risk with every treatment or procedure. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.