This targeted approach is possible when we have identified a probable parathyroid tumor on preoperative imaging. Only the abnormal parathyroid tumor is removed and very little other dissection is needed. Intraoperative PTH testing is used to confirm that the correct gland has been removed and that you only had one parathyroid tumor.
Four-gland Parathyroid Exploration
When all preoperative imaging is negative or inconclusive, all four of your parathyroid glands will be examined at the time of parathyroid surgery. The surgeon will then decide if one or more than one parathyroid gland needs to be removed. Intraoperative PTH testing is used to confirm that the correct gland(s) have been removed.
All of your parathyroid glands will also be examined if your PTH levels do not fall appropriately after a single gland is removed during a focused parathyroidectomy.
Re-operative parathyroid surgery
Occasionally, you may need a second parathyroid surgery because of recurrence (4-5% at 10 years) or because your first surgery did not result in a cure. It is important that this surgery is performed by a specialist because there is a lot of scar tissue and there is a small increased risk of complications (less so in experienced hands). Ideally, the parathyroid tumor should be localized on imaging before having this type of surgery.
- Everyone can eat, drink, and talk that same day right after surgery
- While you may feel some fatigue for 2-3 days (general anesthesia), you will be able to perform your normal activities.
- Most people only take a few days off from work.
- You will have your serum calcium level checked the day after surgery to again confirm that the parathyroidectomy was successful.
- Most patients heal very well from surgery and have minimal residual parathyroid surgery scar at 6 months.
- The size of the incision will depend somewhat on if we are able to localize the hyperfunctioning parathyroid gland before surgery. However, all parathyroid surgeries are “minimally invasive parathyroidectomies” and almost all incisions are between 1.5-3.5 cm in length. Additionally, if you have a neck crease, we try to hide the parathyroidectomy scar in that line. All sutures are dissolvable.