Parathyroidectomy
Parathyroidectomy is the surgical removal of one or more of the four parathyroid glands. This procedure is used to remove an adenoma or hyperplasia of these glands when they are producing excessive parathyroid hormone, a condition termed [hyperparathyroidism|]. The glands are usually four in number and located adjacent to the posterior surface of the thyroid gland, but their exact location is variable. When an elevated level is found, a sestamibi scan or an ultrasound may be performed in order to confirm the presence and location of abnormal parathyroid tissue.
Indications
The main indication for parathyroidectomy is primary , a condition in which one or more of the parathyroid glands produce excessive parathyroid hormone. Not all cases of primary require surgery, but it is recommended if the condition causes significant symptoms or if it affects the kidneys or bone health, and also in people under50 even if they do not have symptoms. It is not always possible to anticipate if a parathyroid tumor is malignant. Any suspicion of parathyroid carcinoma is therefore also an indication for surgery.Parathyroidectomy may also be required in secondary . This situation arises mainly in people with severe chronic kidney disease in which the parathyroid glands are overactive to compensate for the low calcium and vitamin D levels often present in. In many cases, the parathyroid hormone production improves when these abnormalities are treated with medication. A small proportion, however, have persistently raised hormone levels six months after treatment has started, thought to be autonomous production of hormone by the glands and loss of feedback mechanisms. In this situation surgical may be required, especially if calcium and phosphate levels remain elevated, there is calcium deposition in the wall of blood vessels or there is worsening bone disease. In people on kidney dialysis, can improve survival. It does appear that the procedure may be underused.
Procedure
The operation requires general anesthesia or local anesthesia. The surgeon makes an incision around long in the neck just under the larynx, and locates the offending testing using sestamibi scanning can help identify the location of glands. It can also be used to limit the extent of surgical exploration when used in conjunction with parathyroid hormone monitoring. The particular problem or will determine how many of the parathyroid glands are removed. Some parathyroid tissue must be left in place to help prevent [hypoparathyroidism|].Recovery after the operation tends to be swift. The level is back to normal within 10 to 15minutes, and can be confirmed by intraoperative rapid assessment during the operation. However, the remaining may take hours to several weeks to return to their normal functioning levels. Calcium supplements are therefore often required to prevent symptoms of hypocalcemia and to restore lost bone mass.
The patient is placed in a semi-Fowler position and the neck is extended. An abbreviated Kocher incision is made and the platysma muscle is dissected horizontally. The strap muscles are released off of the thyroid gland. Then the thyroid gland is mobilized and the parathyroid arterial is The entire parathyroid adenoma is identified and dissected out. monitoring can begin at this time and will show falling levels if the entire adenoma has been resected.