Parathyroidectomy

What are the parathyroid glands?

The parathyroid glands are small glands behind the thyroid gland that regulate your body’s calcium levels. These glands sense the amount of calcium in your blood stream. Normally, when the glands sense low calcium levels, parathyroid hormone (PTH) is secreted to increase the calcium level in your blood. When the calcium level is too high, the parathyroid hormone decreases. Parathyroid hormone increases calcium levels in your blood stream in multiple ways. It tells your kidney to reabsorb more calcium from the blood stream and make more active Vitamin D. Vitamin D helps the gut absorb more calcium. Lastly, it tells cells in your bones to breakdown bone because of the large amount of calcium stored in bones.

Parathyroid Gland

What happens when parathyroid glands function abnormally?

Parathyroid glands can enlarge and start to secrete hormone abnormally without regard to the blood levels of calcium. This is called primary hyperparathyroidism. Excess calcium in the bloodstream can cause many symptoms such as upset stomach, nausea, vomiting, thirst, abdominal pain, frequent urination, muscle weakness, lethargy, fatigue, and bone pain. This can also lead to cardiac arrhythmias, osteoporosis, and kidney stones. This can be diagnosed if you have elevated calcium levels and your PTH level is also elevated.

How is primary hyperparathyroidism treated?

Primary hyperparathyroidism can be treated surgically. Because there are typically four glands, surgery is much easier and faster if the surgeon knows where to look first. Imaging studies are often done to look for the abnormal gland. This often involves obtaining a nuclear “sestamibi” scan to look for abnormal activity on one side of the neck. Another imaging study such as an ultrasound of the neck may also be obtained to verify the location of the abnormal gland.

How is the surgery done?

If imaging studies were able to localize the hyper-secreting gland, a minimally invasive parathyroidectomy with PTH assay is done. Usually a small incision is required since the both sides of the neck do not have to be explored. During the surgery, your PTH level will be checked before and after the offending gland is removed. PTH levels should decrease to normal allowing us to confirm that the hyper-secreting gland was removed.

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