Parathyroidectomy

The parathyroid glands

Your parathyroid glands are four small glands attached to your thyroid gland, at the base of your neck. They are endocrine glands, meaning that they secrete hormones into your bloodstream. Your parathyroid glands make and secrete a hormone called parathyroid hormone. Parathyroid hormone controls the level of calcium in your blood.

About parathyroidectomy

Your parathyroid glands are four small glands usually located around the front of your windpipe (trachea) at the base of your neck. They produce parathyroid hormones that control the level of calcium in your blood. Having the incorrect level of calcium in your blood can cause problems with your nerves and bones. An operation to remove one or more of these glands is called a parathyroidectomy.

You usually have a parathyroidectomy to treat a condition called hyperparathyroidism. Hyperparathyroidism is when your parathyroid glands release too much parathyroid hormone and this causes the level of calcium in your blood to be too high. You may also have the operation to treat a tumour of the parathyroid glands.

There are three different types of hyperparathyroidism – primary, secondary and tertiary. The type you have depends on what is causing your parathyroid gland to release too much hormone. All three types of hyperparathyroidism can be treated with a parathyroidectomy. See our common questions for more information.

Diagnosis of parathyroid disease

Hyperparathyroidism is usually diagnosed with tests to check the level of calcium and parathyroid hormone in your blood and urine.

Tumours of the parathyroid glands can be malignant (cancerous) or benign (non-cancerous). Most tumours of the parathyroid glands are benign. If you have a tumour on your parathyroid glands, your surgeon or another specialist at the hospital may take a biopsy of your tumour. To do this he or she will remove a small piece of your parathyroid gland with a needle and examine it under a microscope.

You may also have an X-ray or a scan to look inside your neck. These might include ultrasound, MRI or CT scans. You may also have a positron emission tomography (PET) scan or a sestamibi scan. These tests involve you being injected with a very small amount of radiation that collects in the parathyroid glands and highlights the position of the glands under a scanner.

What are the alternatives to parathyroidectomy?

Hyperparathyroidism can sometimes be treated with medicines. Cancer of the parathyroid glands may be treated with chemotherapy or radiotherapy, but surgery is the most effective treatment for this type of cancer.

Preparing for a parathyroidectomy

Your surgeon will explain how to prepare for your parathyroidectomy. If you smoke, you will be asked to stop, as smoking increases your risk of getting a wound infection, which can slow your recovery.

A parathyroidectomy is usually done under general anaesthesia. This means you will be asleep during the operation. If you’re having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

At the hospital, your nurse may check your heart rate and blood pressure and test your urine.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

Your surgeon will discuss with you what will happen before, during and after your parathyroidectomy, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during a parathyroidectomy

If you have hyperparathyroidism, the parts of your parathyroid glands that are producing too much hormone will be removed. If you have a tumour on one or more of your parathyroid glands, only the glands that are affected by the tumours will be removed and any others will be left in place. 

Standard parathyroidectomy

This operation usually takes about two hours.

Once the anaesthetic has taken effect, your surgeon will make a cut about three to 10cm long into your lower neck. If you already have a crease in your lower neck, the cut will be made here so any scarring is less prominent. He or she will locate all of your parathyroid glands and then remove the affected ones.

If all four glands are affected, all of them except for a portion of one will be removed. Your surgeon will close the cut with stitches or surgical clips.

Directed parathyroidectomy

If only one of your parathyroid glands needs to be removed, it may be possible for your surgeon to operate using a slightly different technique. This is called a directed parathyroidectomy or a minimally invasive parathyroidectomy. Before beginning the operation, your surgeon will use scans to find the position of your affected parathyroid gland. Finding the gland in advance means he or she can make a smaller (about 2cm) cut in your neck above the affected gland to remove it during the operation.

Your surgeon may do this procedure under local anaesthesia and you may not need to stay overnight in hospital. The operation is shorter and you may recover more quickly than you would after a standard parathyroidectomy. However, this technique isn’t always appropriate or available in all hospitals.

What to expect afterwards

When you wake up, you may have a catheter to drain urine from your bladder into a bag. You may also have one or two fine tubes running out from your wound. These drain fluid into another bag and are usually removed two or three days after the operation.

The level of calcium in your blood will be checked while you're in hospital. You will need to have this measured in the weeks following your operation as well.

You may have a sore throat for a few days after the procedure. You may need pain relief to help with any discomfort as the anaesthetic wears off.

If you have had a standard parathyroidectomy, you should be able to go home four or five days after the procedure.

If you had general anaesthesia, you may need to rest until the effects of the anaesthetic have passed. General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations, and always follow your surgeon’s advice.

If you have dissolvable stitches, the amount of time it takes for them to disappear will depend on the type of stitches you have. They usually disappear in around two to three weeks, but it can sometimes take longer. If you have non-dissolvable stitches or surgical clips, your surgeon or a nurse will let you know when they will be removed.

Recovering from a parathyroidectomy

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You will be able to carry out your usual activities once you get home. You can eat as you would normally.

Sometimes there isn't enough parathyroid gland left behind after the operation to control your calcium levels so you may need to take calcium replacement medicine. This is more likely if all of your parathyroid glands were removed. You may need to take vitamin D supplements too.

If you feel tingling or spasms in your fingers or toes, contact the hospital or your GP, as this can be a sign that there isn't enough calcium in your blood.

What are the risks?

As with every procedure, there are some risks associated with a parathyroidectomy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

You may have a scar at the base of your neck, but this usually heals well.

Complications

This is when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Complications of a parathyroidectomy are listed below.

  • There is a small chance that your surgeon won't be able to find the affected parathyroid gland. If this happens, you may need further surgery.
  • Your vocal cords might get injured during the operation, which can make your voice hoarse. Often an injury to the vocal cords will heal on its own a within a few weeks of surgery, but there is a chance that your voice may sound different permanently.
  • Your thyroid gland, which is next to your parathyroid glands, may be damaged during the operation. A portion of your thyroid gland may be removed during the parathyroidectomy. However, this doesn’t usually cause any problems.

What will happen if my thyroid gland needs to be removed?

Answer

If you’re having surgery to remove a tumour on your parathyroid gland, it’s possible that you will need part of your thyroid gland removed during the operation. Usually this will not cause you any problems.

Explanation

Your parathyroid glands are attached to your thyroid gland. If you have a tumour on one or more of your parathyroid glands, your surgeon may remove all, or part, of the nearest half of your thyroid gland. He or she may also remove some of the tissue that surrounds your thyroid during the operation.

If only a portion of your thyroid gland is removed, it will continue to work as normal. You won’t need to take thyroid hormone replacement medicines unless your entire thyroid has been removed, and this is unlikely.

Is cancer of the parathyroid gland common?

Answer

No, cancer of the parathyroid gland is very rare.

Explanation

Tumours of the parathyroid glands can be malignant (cancerous) or benign (non-cancerous). Most tumours of the parathyroid glands are benign.

Parathyroid tumours can cause the glands to produce too much parathyroid hormone, which raises the level of calcium in your blood. This can lead to weakness in your muscles, thinning and painful bones, kidney stones and tiredness.

Speak to your GP if you’re worried about cancer of the parathyroid gland.

What are the different types of hyperparathyroidism?

Answer

There are three different types of hyperparathyroidism – primary, secondary and tertiary hyperparathyroidism. The type you have depends on what is causing your parathyroid gland to release too much hormone. All three types of hyperparathyroidism can be treated with a parathyroidectomy.

Explanation

Your parathyroid glands produce and release a hormone called parathyroid hormone into your bloodstream. This hormone controls the level of calcium in your blood. Having the correct level of calcium in your blood is important to keep your bones, nerves and muscles healthy. If your parathyroid glands are releasing too much parathyroid hormone, you will develop a condition called hyperparathyroidism. This causes calcium to leach out of your bones and into your blood.

Primary hyperparathyroidism happens when a benign (non-cancerous) tumour on your parathyroid glands causes them to produce too much hormone. This is the most common reason for having a parathyroidectomy.

Secondary hyperparathyroidism can be caused by vitamin D deficiency or chronic kidney disease. These conditions reduce the level of calcium in your blood. So your parathyroid glands respond by releasing too much parathyroid hormone to try to increase calcium levels again.

If you have had secondary hyperparathyroidism for a long time, you can develop tertiary hyperparathyroidism. This is when your parathyroid glands continually produce too much parathyroid hormone, causing the level of calcium in your blood to increase by too much. Usually all of your parathyroid glands are affected. Tertiary hyperparathyroidism is most common in people with chronic kidney failure.