What is a Parathyroidectomy?

Parathyroidectomy is surgical removal of one or more parathyroid glands in order to treat hyperparathyroidism. When performed to treat primary hyperparathyroidism, only a single enlarged gland (parathyroid adenoma) is removed. When performed to treat secondary hyperparathyroidism, a subtotal parathyroidectomy is generally performed, in which at least three of the four glands are removed.

Parathyroidectomy is performed through an incision in the neck under general anesthetic. During excision of a parathyroid adenoma, the surgeon identifies the enlarged parathyroid gland on the posterior aspect of the thyroid gland and removes it. During subtotal parathyroidectomy, all four parathyroid glands are identified and three to three and a half glands are removed, leaving only a small remnant of parathyroid tissue in the body.

Diagnosis and Tests

Locating parathyroid glands during surgery can be relatively easy when they are enlarged. However, from time to time, finding the glands can be difficult due to the variability of their locations in the neck. Various methods can be used to assist the surgeon in localizing the adenoma, in order to make removal easier. During the preoperative workup, a nuclear medicine Sestamibi scan is usually performed to predict the location of the adenoma. Other studies, such as ultrasound, may give confirmatory information. During surgery, repeat localization with Sestamibi tracer can be employed to direct the surgeon to the tumor. When this method is used, a dose of tracer is administered just prior to surgery. The surgeon uses an instrument to detect uptake of the radioactive material in the adenoma, directing the surgery to that area. These methods are not applicable to subtotal thyroidectomy for secondary hyperparathyroidism, in which the surgeon must rely solely on surgical landmarks to locate the glands.

Treatment and Care

Parathyroidectomy is performed through an incision in the neck under general anesthetic. During excision of a parathyroid adenoma, the surgeon identifies the enlarged parathyroid gland on the posterior aspect of the thyroid gland and removes it. During subtotal parathyroidectomy, all four parathyroid glands are identified and three to three and a half glands are removed, leaving only a small remnant of parathyroid tissue in the body.

Confirming removal of parathyroid glands: Glands removed during surgery are sent to the pathologist, who confirms that the tissue is parathyroid tissue. Parathyroid hormone levels can be checked during surgery before and after removal of a parathyroid to confirm that the gland removed is responsible for the elevated parathyroid hormone.