Parathyroid Glands Surgery
The parathyroid glands are small in size and their total weight is about 100-140 mg. They are located in the cervix, on the posterior surface of the thyroid gland. The 90% of patients have 4 parathyroid glands, but there may be fewer or more.
What is the function of the parathyroid glands?
The parathyroid glands produce a parathyroid hormone (PTH), the parathormone that plays a very important role in the regulation of calcium levels in the body. The normal blood calcium values are 9-10.5 mg/dl. Apart from its structural use in bones, calcium also plays an important role in many other physiological functions of the body. Parathormone regulates the concentration of calcium in the blood by acting on the bones (it increases release) and the kidneys (it increases the reabsorption).
What is hyperparathyroidism?
The term hyperparathyroidism refers to the excessive secretion of parathyroid hormone (PTH) (or parathormone). It may be primary (i.e. your parathyroid glands make too much PTH, which causes the level of calcium in your blood to rise), secondary (i.e. the overactivity of the parathyroid glands occurs in response to another condition that’s causing calcium loss) and tertiary (i.e. when secondary hyperparathyroidism goes untreated for too long).
Primary hyperparathyroidism is the most common cause of hypercalcemia in the general population. It usually occurs in women after the age of 45.
The autonomic secretion of parathyroid hormone (parathormone) by the parathyroid glands may be due to:
- 80-85% solitary parathyroid adenoma (a single benign (noncancerous) tumor that appears in one or more of the parathyroid glands)
- 12% hyperplasia of all glands (increase in volume and functionality of all 4 glands)
- 1% parathyroid cancer
- 3% multiple adenomas (multiple benign tumors in more than one parathyroid gland).
What is the treatment for hyperparathyroidism?
The only effective way to treat primary hyperparathyroidism is surgical removal of the affected gland(s). The surgeon will remove only those glands that are enlarged or have a tumor. If there is hyperplasia of all parathyroids, then 3½ glands are removed. The remaining parathyroid gland can be marked and left in its place in the cervix or placed in the patient’s arm for easier access if needed in the future.
The surgical operation is performed under general anesthesia, with an incision identical to that of thyroid gland surgeries. The surgical incision is made in such a way that it is “hidden” in a natural skin crease which acts as camouflage and the wound is sutured with an intradermal suture (plastic surgery suture).
The patient is discharged from the clinic, usually within 24 hours. After surgery, blood calcium is absorbed by the bones causing a transient and expected hypocalcemia. If the patient shows symptoms due to hypocalcemia despite taking oral calcium supplements, the hospitalization can be extended for a few more days until the normal balance of calcium levels is restored.
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