What is a parathyroidectomy?

Indications and Procedures

The parathyroid glands are four structures attached to the rear of the thyroid gland, which is found in the neck. Their main function is the secretion of parathyroid hormone (PTH), a protein that regulates the concentration of blood calcium. Abnormalities in proper calcium concentration can lead to bone demineralization, neuromuscular problems, or renal (kidney) damage.

Parathyroidectomy is occasionally warranted under conditions of hyperparathyroidism: the excess secretion of PTH. Hyperparathyroidism most commonly results in excess resorption of bone calcium, causing skeletal pain or loss of height. The demineralization may also lead to fractures of the spine or long bones, which may be accompanied by extreme muscle weakness and frequent urination. Since the patient may be asymptomatic, diagnosis is most commonly made on the determination of excess serum and urine calcium. X-rays may also indicate bone abnormalities resulting from the resorption of calcium. The condition itself may be caused by hyperplastic (overactive or enlarged) glands, or in less common circumstances (2 percent of cases), hyperparathyroidism may result from a parathyroid adenoma (a benign tumor on a gland).

Asymptomatic patients, or patients with only mildly elevated blood calcium, may not need treatment. Should symptoms become more severe, surgical procedures may be necessary, generally involving the removal of excess parathyroid tissue. If the hyperplasia involves all four parathyroid glands, three of the glands are usually removed, with resection of the fourth. If the cause of the PTH elevation is an adenoma, it is necessary to remove the tumor surgically.

Uses and Complications

Since the primary symptom of hyperparathyroidism is excess blood calcium, the removal of excess tissue may suddenly reduce calcium levels to normal. The rapid fall of calcium may cause a transient tetany (involuntary muscle contractions), but otherwise recovery from such surgery parallels any other surgical procedure. PTH and calcium levels must continue to be monitored postoperatively. If parathyroidectomy results in excessively low PTH levels, it may be necessary to provide lifelong diet supplements of calcium and vitamin D. Surgical complications include injury to the thyroid gland and/or to the vocal cords.

Bibliography

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