Parathyroidectomy is a surgical procedure used to remove one or more of the parathyroid glands. While these tiny glands may not be widely known, they have a big role in keeping your body’s calcium levels in check. When one or more of them become overactive or enlarged, it can throw off the entire system, leading to various symptoms and complications.
This procedure is often the most effective—and sometimes the only—way to correct certain parathyroid disorders, particularly hyperparathyroidism.
This article will explore the different types of parathyroidectomy surgery available to patients.
Understanding the Parathyroid Glands
The human body has four parathyroid glands located behind the thyroid in the neck. These glands produce parathyroid hormone (PTH), which helps regulate calcium and phosphorus levels in the blood. When functioning properly, these glands maintain a healthy balance that supports bone strength, nerve function, and muscle activity.
However, when one or more glands start producing too much PTH—often due to a benign tumor called an adenoma—it leads to a condition known as primary hyperparathyroidism. This condition can cause elevated calcium levels in the blood, potentially leading to bone loss, kidney stones, fatigue, and other systemic issues. In such cases, surgery becomes necessary.
When Is Types of Parathyroidectomy Surgery Recommended?
Types pf Parathyroidectomy Surgery is most often performed in patients with primary hyperparathyroidism. In some cases, it may also be done for secondary or tertiary hyperparathyroidism, especially in patients with chronic kidney disease or post-kidney transplant who develop persistently high PTH levels. The decision to go for surgery depends on calcium levels, bone health, kidney function, patient age, and symptom severity.
When non-surgical treatments fail or when complications like kidney stones or osteoporosis arise, parathyroidectomy becomes the definitive treatment.
Types of Parathyroidectomy Surgery
Once the decision to proceed with parathyroidectomy has been made, patients go through several steps before surgery. This includes lab tests to confirm the diagnosis, imaging tests to locate the overactive gland(s), and a thorough preoperative evaluation.
Common imaging studies include a sestamibi scan, neck ultrasound, or a 4D CT scan. These tests help the surgeon identify which gland or glands are abnormal and guide the surgical approach.
Your healthcare provider may also order blood tests to check your calcium, PTH, and vitamin D levels, as well as kidney function. In some cases, medications may be adjusted or stopped in the days leading up to the operation.
Most patients are advised to stop eating or drinking after midnight on the night before surgery. You may also be asked to avoid certain medications, especially blood thinners, to reduce the risk of bleeding.
The Surgical Procedure
Parathyroidectomy is usually performed under general anesthesia, meaning you will be asleep during the surgery. The procedure typically takes one to two hours, depending on the complexity and the number of glands involved.
The surgeon begins by making a small incision in the lower part of the neck. Through this incision, the surgeon carefully identifies the parathyroid glands, sometimes using a nerve monitor to protect the nearby vocal cord nerves.
If only one gland is enlarged or overactive, it is removed. This is known as a focused or minimally invasive parathyroidectomy. If multiple glands are abnormal, a bilateral neck exploration may be done to examine and possibly remove more than one gland. In cases of secondary or tertiary hyperparathyroidism, three and a half glands may be removed, leaving a small portion of one gland to continue functioning.
To ensure the surgery was successful, the surgical team may perform intraoperative PTH monitoring. PTH levels drop rapidly once the abnormal gland is removed. A significant drop in PTH during surgery is a strong indicator that the problem has been corrected.
Once the problematic gland(s) have been removed and bleeding is controlled, the incision is closed with sutures or skin glue. A small bandage is applied, and most patients do not need a drain.
After Surgery: What to Expect
After the procedure, you will be taken to a recovery room where your vital signs are monitored. In many cases, parathyroidectomy is done on an outpatient basis, and patients can go home the same day. Others may stay overnight, especially if they have underlying health conditions or more complex surgical needs.
You may have a sore throat, mild neck pain, or a hoarse voice, which usually improve within a few days. Your surgeon may prescribe pain medication or suggest over-the-counter pain relievers. It’s important to follow all post-operative instructions, including wound care and any dietary recommendations.
One of the key things your healthcare team will monitor after surgery is your calcium level. Because your body has become used to high PTH levels, suddenly correcting that imbalance can cause temporary low calcium (hypocalcemia). Symptoms may include tingling in the fingers or lips, muscle cramps, or even twitching.
To prevent or manage this, you may be prescribed calcium supplements, sometimes along with vitamin D. These are usually temporary until your calcium levels stabilize.
Recovery Timeline
Most patients recover quickly from parathyroidectomy. Light activity can typically be resumed within a day or two. Most people return to work within a week, although some may need more time depending on their job and individual recovery.
The incision site heals within a few weeks, and any scarring is usually minimal. In some cases, follow-up blood work is scheduled to monitor calcium and PTH levels. Bone density may also be rechecked several months after surgery to assess improvement.
Voice changes, if they occur, are typically temporary. Permanent voice changes are very rare and usually related to injury of the recurrent laryngeal nerve, which is carefully protected during surgery.
Risks and Complications
Like all surgical procedures, parathyroidectomy carries some risks. These include bleeding, infection, injury to the surrounding structures such as the thyroid or nerves, and low calcium levels. However, in experienced hands, parathyroid surgery is considered very safe and has a high success rate.
If part of a parathyroid gland is unintentionally left behind or if another gland becomes overactive later, a second surgery might be needed, though this is uncommon.
Choosing a skilled and experienced endocrine or head and neck surgeon can significantly reduce the risk of complications.
Conclusion
Parathyroidectomy is a highly effective procedure with a strong track record of curing primary hyperparathyroidism and improving quality of life. For patients suffering from symptoms like fatigue, bone pain, kidney stones, or unexplained high calcium levels, surgery can offer long-term relief and prevent further complications.
Understanding the procedure, what it involves, and how recovery unfolds can help you feel more confident and prepared. If you’ve been recommended for a parathyroidectomy, talk openly with your surgeon about your condition, expectations, and any concerns you have.
