The parathyroid glands are the smallest organ in the body, and were the last to be discovered. There are four glands in the neck, usually located behind the thyroid gland (in the middle and lower part of the neck), with two on the left and two on the right side. Their position can vary, however, and occasionally they are difficult to find, as their normal size is only around two to three millimetres.
Why is parathyroid surgery performed?
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 is primary hyperparathyroidism.
Primary hyperparathyroidism is caused by the glands producing too much parathyroid hormone. The high 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 (a reduction in the density of bones, with a propensity for fractures). Approximately 80–90% of people with primary hyperparathyroidism have 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 four parathyroid glands), and very rarely it can be due to parathyroid cancer (less than 1%).
Investigations
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).
The operation
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, where all the parathyroid glands are found; one may be removed on its own, or up to three and a half parathyroid glands may be removed to try to lower your calcium 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 (usually about four to five centimetres, which we try to hide in a natural skin crease). The operation time can vary between 30 minutes and 2 hours, depending on how easily the swollen parathyroid (adenoma) is located. Other risks are rare but include post-operative bleeding or infection, ongoing 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 to 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. You will be required to stay in hospital for one night after the operation, to check that your calcium levels are stable before you are discharged home.
After the operation
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 one week after the procedure, depending on the type of material used to close the incision.
If you would like to book an appointment to discuss your symptoms, please get in touch with our Practice Management Team by telephone on 01233 564455 or by email at info@kentandsussexent.com.