Parathyroidectomy is surgery to remove one or more parathyroid tumors from your neck.

All patients have a minimally invasive parathyroid surgery (ie, a very small incision) to remove the abnormal parathyroid glands. It is as a same day, outpatient procedure. Surgery is performed under general anesthesia and all patients have Intraoperative PTH testing. There is no age that is “too old” for parathyroid surgery – it can have benefit in people of all ages when done for the appropriate reasons.

All patients will have a pre-operative parathyroid imaging to try and localize the parathyroid tumor before surgery.

Intraoperative PTH testing

State of the art surgical technique

Your parathyroid hormone level will be tested 4 times while you are asleep during surgery to make sure the correct parathyroid gland(s) have been removed before you are awoken from anesthesia. This is known as “intraoperative PTH testing”. It is the most sensitive and accurate intraoperative method for determining if your parathyroid disease has been ‘cured’ at the time of surgery.

Your PTH level is expected to be normal at the end of the operation.

Types of Parathyroid Surgery

Focused Parathyroidectomy

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.

What to Expect the Day of Surgery – Commonly Asked Questions

The parathyroidectomy procedure can take anywhere from 30 minutes to three hours once you are asleep. It depends on how quickly we can find and confirm the removal of the abnormal gland.

Almost all patients that undergo a parathyroidectomy will go home that same day.

One of the very rare side effects of parathyroid surgery is injury to the recurrent laryngeal nerve that controls your voice. This complication occurs in less than 0.5 percent of patients. If you had more extensive parathyroid surgery, you may be hoarse after surgery for a short period of time but this is generally temporary.

Yes. In all cases, Intraoperative PTH testing is used to ensure that your parathyroid hormone levels are normal at the end of the operation.

After Parathyroid Surgery

Recovery

(For more information please refer to Parathyroidectomy What to Expect)

  • 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.

Cosmetic result

  • 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.