Parathyroidectomy

Parathyroidectomy is the surgical removal of one or more parathyroid glands, typically performed to treat hyperparathyroidism. The four parathyroid glands, located near the thyroid, regulate calcium balance in the body through parathyroid hormone (PTH).

Indications include primary hyperparathyroidism, most often due to a benign parathyroid adenoma, with symptoms of hypercalcemia or end-organ effects such as kidney stones, bone loss, or neurocognitive changes. Surgery is also considered for multigland disease, suspected parathyroid carcinoma, or persistent hypercalcemia despite conservative measures. In secondary or tertiary hyperparathyroidism (common in chronic kidney disease), surgery is reserved for refractory cases with uncontrolled calcium or bone disease.

The operation is usually performed under general anesthesia. Depending on imaging localization, surgeons may perform a focused minimally invasive parathyroidectomy or a standard neck exploration to identify all glands. Intraoperative parathyroid hormone (PTH) monitoring helps confirm removal of hyperfunctioning tissue. If multiple glands are removed, autotransplantation of a portion of parathyroid tissue into another site (often the forearm) may be performed to maintain calcium regulation.

Postoperative care focuses on monitoring calcium and phosphorus levels, assessing voice and swallowing function, and ensuring wound healing. Calcium supplementation and vitamin D may be needed, particularly if several glands were removed or bone disease is present. Most patients experience symptom relief and normalization of calcium levels, with cure rates high for solitary adenomas.

Risks include injury to the recurrent laryngeal nerve causing hoarseness, temporary or permanent hypocalcemia (hungry bone syndrome), infection, hematoma, and injury to nearby structures. Reoperation may be necessary if hyperparathyroidism recurs or persists.