Parathyroid surgery
Parathyroidectomy is the surgical removal of one or more parathyroid glands. The parathyroid glands are four rice-sized glands located on back of the thyroid gland in the neck. The parathyroid glands make parathyroid hormone (PTH), which controls the levels of calcium in the body. In patients with hyperparathyroidism, one or more parathyroid glands become enlarged and oversecrete parathyroid hormone, causing levels of calcium to rise in the blood. Surgery to remove the enlarged gland (or glands) is the only definitive treatment for the disorder and cures it in 95 percent of cases.
The risks of the Parathyroid surgery
There are three main risks for parathyroidectomy that includes:
- Recurrent laryngeal nerve injury: This nerve controls your vocal cords and if injured you will have a hoarse voice. There is a 1% chance of permanent hoarseness and a 5% chance of temporary hoarseness.
- Bleeding: There is a 1/300 risk of bleeding with your operation. This is the main reason you stay overnight in the hospital.
- Low blood calcium: There are parathyroid glands that lie behind your thyroid gland that help to control your blood calcium levels. If they are injured or removed during your operation, then your blood calcium can be too low. This would require you to take calcium and vitamin D supplementation. There is a 1% chance of permanent calcium supplementation and 5% chance of temporary calcium supplementation.
Types of Parathyroid Surgery
- Bilateral exploration: was the traditional surgical approach to parathyroid surgery and may also be referred to as open parathyroidectomy; this approach has proven over time to be highly successful with cure rates of 95% or greater when performed by an experienced surgeon.
- Focused exploration consists of “going after” a single abnormal gland and removing it.
- Radioguided parathyroidectomy is a type of focused parathyroidectomy. The surgeon uses a handheld gamma probe in the operating room to identify the hyperactive gland during surgery.
- Video-assisted parathyroidectomy is also known as minimally invasive video-assisted parathyroidectomy.
- (Vagus) nerve stimulation: This is a method for quality control in parathyroid surgery. In one study, vagus nerve stimulation in the identification and assessment of the integrity of the recurrent laryngeal nerve (RLN) during parathyroid surgery was assessed. Vocal fold function was assessed pre- and post-operatively in all patients undergoing parathyroid surgery. Vagus nerve stimulation was performed in 21 patients without adverse sequelae.
Reference:
https://general.surgery.ucsf.edu/conditions–procedures/parathyroidectomy.aspx
http://endocrinediseases.org/parathyroid/surgery_overview.shtml
https://my.clevelandclinic.org/health/treatments/7015-parathyroid-surgery
https://www.ncbi.nlm.nih.gov/pubmed/10748828
https://www.uofmhealth.org/conditions-treatments/parathyroid-surgery
