People who have hyperparathyroidism can benefit from parathyroid surgery. First introduced in the 1920sa parathyroid surgery is the best treatment option for this condition. Hyperparathyroidism negatively impacts the bones and causes health problems such as kidney stones, cardiovascular ailments, and interfere with the brain functioning.
Parathyroid surgery is a relatively safe procedure, which was further improved with the minimally invasive approach. Most people don’t complain much about the pain from this surgery. To learn more about this procedure, keep reading.
What is parathyroid surgery?
Parathyroid surgery, also known as parathyroidectomy, is a minimally invasive procedure performed to remove parathyroid glands from the neck. Depending on the condition, the parathyroid gland surgery is conducted either to remove the affected parts of the glands or to remove them completely.
The parathyroid glands situated in your neck produce the parathyroid hormone (PTH), which helps in regulating the levels of calcium and phosphorus in the blood. When the parathyroid glands stop working properly, a parathyroidectomy surgery may be recommended to remove abnormal glands and correct the levels of calcium and phosphorus in the blood and prevent further complications.
There are four parathyroid glands located behind the thyroid glands at the bottom of the neck. A surgeons will test the functioning of each gland during the procedure and leave properly working parathyroid glands intact during surgery.
Why is parathyroid surgery performed?
People who have high levels of PTH hormones—hyperparathyroidism—in their body need a parathyroidectomy. Generally, people have primary hyperparathyroidism that can be treated by removing the abnormal parathyroid gland. This condition involves the enlargement of one or more of the four parathyroid glands , which causes PTH overproduction. Primary hyperparathyroidism is often caused by parathyroid adenoma, which is a benign growth—non-cancerous tumour—of the glands.
If a person gets routine blood tests, there is a high chance that they will be diagnosed before any significant symptoms start to show. Although the following symptoms hint at hyperparathyroidism, they are not conclusive, and one should consult their doctor to confirm a diagnosis:
- Osteoporosis (weak bones)
- Excessive urination
- Abdominal pain
- Lethargy or weakness
- Kidney stones
- Joint and bone pain
- Forgetfulness or depression
- Nausea and loss of appetite
Sometimes people may get hyperparathyroidism due to an underlying condition that leads to a decrease in the calcium levels; the parathyroid glands start producing more and more PTH to cover up the low levels. Some kidney diseases and certain intestinal diseases may cause secondary hyperparathyroidism. Treatment for this type usually requires addressing the underlying condition in addition to managing calcium levels in the blood.
Parathyroid surgery procedure
First, the doctor will give a patient general anaesthesia. The patient will also be administered antibiotics and other medicines during this surgery as preventive measures.
The surgeon will start by making an incision of about 2–2.5 cm at the base of the neck according to their planning from pre-operative imaging. During a minimally invasive parathyroidectomy procedure, the surgeon will use spatulas and other tools to expose the abnormal parathyroid gland and remove it. The PTH levels are measured before removing the abnormal gland and after every 5-minute interval after removal. If the PTH levels are not normal, the doctor may check other glands; this procedure is also referred to as four gland parathyroid exploration.
However, if the surgeon is sure that the rest of the glands are normal, they will close the wound and tie it up with absorbable sutures.
After surgery care
The patient will be kept under observation overnight and may be discharged the next day depending on their health status. It is normal to experience some discomfort, pain, and swelling in the neck after the parathyroid operation. Some patients may be advised to take calcium supplements or up their calcium intake to avoid calcium deficiency.
If the patient has external stitches, they may need to visit the doctor again after a week or two to get them removed. Besides, regular doctor visits can ensure a speedy recovery and help the patient maintain a healthy body.
Risks of the parathyroid surgery
A parathyroidectomy does not have many risks apart from the common risks associated with most surgeries, including infection and nerve damage (rare). Some patients experience sore throat due to the breathing tube, but aside short-term hoarseness there are usually no major risks of this surgery.
In rare cases, a patient might get hyperparathyroidism again and need another parathyroidectomy surgery to remove the newly affected gland.
Parathyroid surgery costs in India
Generally, the parathyroidectomy costs around INR 55,000 on average, but the cost may go as high as INR 10,26,000 depending on the expertise of the surgeon, type of anaesthesia used, and some other factors.
One can check with their insurance provider for the list of network hospitals that have optimum facilities to conduct a parathyroidectomy.
Who should get a parathyroid surgery?
Parathyroidectomy is the best treatment option for people who have hyperparathyroidism—a condition, which involves elevated levels of calcium due to high PTH levels in the blood. Some people with mild hyperparathyroidism can choose to avoid getting a parathyroid surgery with their doctor’s consent. However, they need to be closely monitored for the rest of their lives.
If a person exhibits any of the following signs, they should consult their doctor and get the surgery:
- Fractures due to decreased bone density
- Kidney stones
- Decreased kidney function with less than 60 GFRCalcium greater than 400 mg in a 24-hour urine test
