Parathyroid – Parathyroid gland resection

The Parathyroid gland is a gland in charge of the calcium level in our body. There are 4 such glands, adjacent to the thyroid gland, and they secrete a hormone called PTH when they identify calcium deficiency in the body. This way, they make sure to maintain a normal level of calcium, which is one of the most important elements in the human body.

There are cases where the parathyroid glands – one of a few of them – do not work properly. This could be a case of hyperactivity, meaning increased production of the PTH hormone, leading to elevation in calcium levels, up to a harmful and dangerous situation; it could be a case of sub-activity, leading to a decreased level of calcium and it can be a lack of response in the body (or the sick gland) to a significant change in calcium concentration in the body, usually leading to a decreased level of calcium as well.

These conditions have many  implications: excess calcium in the body can cause osteoporosis (bone thinning), kidney stones, tiredness, a certain feeling of depression, nausea and headaches; low calcium levels could cause muscle contractions and frequent muscle spasms, change in hair condition, dry skin, weakening of the nails and teeth and more.

General information about Parathyroid

When a problem is discovered in the function of the Parathyroid glands, a doctor would first act to diagnose the problematic gland. The identification is done via special imaging called the Sestamibi scan. After the sick gland was discovered, an accurate diagnosis will be done to understand the problem – hyperactivity, excess activity or lack of response in the body to a change in calcium levels.

If it’s hyperactivity of one of the glands – this is the most common condition in this context – resection of the sick gland will be performed. Removing it will not harm the rate of PTH hormone production, which will continue to be produced in the other glands, and in the amounts needed by the body. In fact, even if only one gland remains of the 4 Parathyroid glands, it will be enough to produce the required amount of PTH.

By the way, even the discovery of a tumor on one of the Parathyroid glands will lead to having surgery during which the tumor or the entire gland will be removed. A tumor could have various implications on the gland, including causing its hyperactivity and increased the production of PTH.

Preparation for Parathyroid gland resection

Parathyroid gland resection will be done under general anesthesia, so there’s usually no need for special preparation, except the Sestamibi scan that will be performed prior to the surgical procedure. In the event of complete anesthesia, you’ll be required to fast several hours before starting the surgery.

Course of action

In the past, Parathyroid gland resections were done in the open approach, via a surgical incision about 10 cm long along the neck. Today, the surgery is much simpler and is usually done through a tiny incision in the neck, at the spot closest to the sick gland (whose location was identified beforehand during the special imaging test).

Another important tool to make these surgeries especially accurate is, in fact, a blood test known as “turbo PTH”, allowing examination of the PTH production rate in the body immediately after resection of the gland. If the blood test indicates a significantly lower level after the resection (when relating to hyperactivity of the gland, of course) – the correct gland was removed. In this case, after 48 hours the calcium level in the body is already expected to stabilize in normal values.

If the PTH level doesn’t decrease, the wrong gland was removed, or there are more sick glands. In this case, the surgery will be expanded and become open surgery.

Parathyroid gland resection is a surgery that lasts about an hour and a half at most today (in the past, these surgeries would last 3 hours or more), and allows discharge after 48 hours, and sometimes even earlier.

side effects

The side effects after the surgery could be bleeding, chronic sub-activity of the Parathyroid gland due to significant harm of the glands’ tissues and a shard decrease in blood calcium levels right after the surgery. These effects are considered rare and there are quick and effective treatments for them.