Parathyroidectomy is a surgical procedure to remove one or more of the parathyroid glands. These tiny glands, located near the thyroid in the neck, play a big role in regulating calcium levels in the body. When they malfunction, it can lead to serious health problems, and surgery may become necessary. But the decision to undergo parathyroidectomy isn’t always straightforward.

What Is the Parathyroid Gland?

The human body has four parathyroid glands, usually located behind the thyroid gland in the neck. Despite their name, they are not related to the thyroid in function. Their main job is to produce parathyroid hormone (PTH), which regulates calcium and phosphate levels in the blood.

When these glands produce too much PTH, it leads to a condition known as hyperparathyroidism. Over time, this disrupts the balance of calcium in the body and can affect bones, kidneys, and other organs. In some cases, medication and monitoring may be enough—but in others, surgery is the best option.

What Is Parathyroidectomy?

Parathyroidectomy is the surgical removal of one or more parathyroid glands. It can be:

Minimally invasive, with a small incision and targeted removal
Traditional or bilateral neck exploration, where the surgeon checks all four glands and removes the problematic one(s)
The goal is to correct calcium imbalance, relieve symptoms, and prevent long-term complications.

When Is Parathyroidectomy Needed?

Primary Hyperparathyroidism

This is the most common reason for parathyroidectomy. In primary hyperparathyroidism, one or more glands become overactive, producing too much PTH. This raises blood calcium levels and can lead to:

Bone loss (osteoporosis or fractures)
Kidney stones
Fatigue, muscle weakness
Depression, memory issues
Abdominal pain or ulcers

While some cases are mild and monitored over time, surgery is recommended if:

Blood calcium is consistently high
Bone density is reduced
Kidney function is affected or stones develop

Secondary Hyperparathyroidism

This condition usually occurs in people with chronic kidney disease (CKD) or vitamin D deficiency. In secondary hyperparathyroidism, the glands become overactive due to low calcium levels or impaired kidney function, rather than a direct problem with the glands themselves.

Initially, secondary hyperparathyroidism is treated medically—with vitamin D, phosphate binders, and other medications. However, parathyroidectomy may be needed when:

PTH levels stay extremely high despite medical treatment
There are symptoms like bone pain, weakness, or fractures
Calcium and phosphorus levels become dangerously unbalanced
Calcification occurs in blood vessels or soft tissues

In these cases, doctors may remove three and a half glands (subtotal parathyroidectomy) or all four glands (total parathyroidectomy) with or without reimplanting part of a gland elsewhere in the body.

Tertiary Hyperparathyroidism

Tertiary hyperparathyroidism happens when secondary hyperparathyroidism becomes permanent, often after a kidney transplant. Even after the underlying kidney issue is resolved, the glands continue to produce too much PTH on their own.

Parathyroidectomy is typically indicated in this condition when:

Calcium levels remain high post-transplant
PTH remains elevated without medical control
There is a risk of bone disease or calcification
Surgery in these cases helps restore calcium balance and protect long-term health.

Parathyroid Cancer (Rare)

Parathyroid cancer is rare, but it can cause very high calcium levels, a palpable neck mass, hoarseness, and severe symptoms.

Parathyroidectomy in these cases is both a diagnostic and therapeutic step. The goal is complete removal of the tumor, along with surrounding tissue, to prevent spread.

This requires a more extensive operation and close follow-up due to the risk of recurrence.

Symptoms That May Indicate the Need for Surgery

Not everyone with parathyroid disease has obvious symptoms. However, some subtle signs may point to a problem that needs surgical correction:

Fatigue or constant tiredness
Bone or joint pain
Frequent urination or kidney stones
Difficulty concentrating (“brain fog”)
Muscle weakness or cramps
Unexplained gastrointestinal discomfort
Emotional changes like anxiety or depression

These may seem unrelated at first, but together, they can indicate high calcium and PTH levels due to parathyroid dysfunction.

How Is the Decision Made?

The decision to go ahead with surgery depends on several factors:

Calcium and PTH levels
Bone density results (DEXA scan)
Kidney function and imaging (ultrasound, Sestamibi scan)
Age and overall health
Severity and impact of symptoms

Your doctor may recommend a wait-and-watch approach in milder cases, with regular monitoring. But if complications develop, parathyroidectomy becomes the most effective treatment.

What Are the Benefits of Parathyroidectomy?

When done for the right reasons, parathyroidectomy can significantly improve quality of life and reduce long-term health risks. Benefits may include:

Normalization of calcium and PTH levels
Prevention of kidney stones and bone loss
Relief from chronic fatigue, brain fog, or mood swings
Better cardiovascular and kidney health
Decreased risk of fractures and osteoporosis

Most patients see noticeable improvement within days to weeks after surgery.

What to Expect From the Procedure

Parathyroidectomy is typically performed under general anesthesia. In most cases:

A small incision is made in the neck
The overactive gland(s) are removed
Intraoperative PTH monitoring may be used to confirm success
Surgery takes 1–2 hours
Patients often go home the same day or after one night

Recovery is usually quick, with minimal discomfort. You may have a sore throat or minor swelling, but serious complications are rare.

Conclusion

Parathyroidectomy isn’t always necessary—but when it is, it can be life-changing. If you’ve been diagnosed with hyperparathyroidism, especially with elevated calcium levels, bone loss, kidney problems, or symptoms affecting your well-being, it’s important to discuss surgical options with your doctor.

Surgery offers a permanent solution in many cases and is often safer and more effective than long-term medication or monitoring alone.

If you’re unsure whether you need surgery, consider getting a second opinion from an endocrine surgeon or endocrinologist experienced in parathyroid disorders.