Parathyroidektomi

Parathyroidektomi is a surgical procedure to remove one or more parathyroid glands. It is most commonly performed to treat hyperparathyroidism, a condition in which the parathyroid glands produce excess parathyroid hormone (PTH). Indications include primary hyperparathyroidism due to solitary adenoma, parathyroid hyperplasia, or rarely carcinoma; secondary hyperparathyroidism in chronic kidney disease, and tertiary hyperparathyroidism after prolonged secondary disease, often in the context of MEN syndromes.

Preoperative localization with high-resolution ultrasound and sestamibi scintigraphy helps identify diseased glands. Additional imaging such as 4D-CT or MRI may be used in complex cases. Intraoperative parathyroid hormone (PTH) monitoring can assist in confirming the removal of hyperfunctioning tissue.

Techniques vary by disease and surgeon preference. The operation can be performed as a focused, minimally invasive parathyroidectomy or as a broader neck exploration. The surgeon exposes the lower neck, locates the parathyroid glands, and removes the diseased gland(s). In subtotal parathyroidectomy or total parathyroidectomy with autotransplantation, a portion of parathyroid tissue is preserved by reimplantation, usually in the forearm muscle, to maintain some parathyroid function.

Postoperative care includes close monitoring of calcium and phosphorus levels and appropriate supplementation with calcium and vitamin D as needed. Hypocalcemia is a common early complication, sometimes due to hungry bone syndrome, and requires management. Other potential risks include hypoparathyroidism, injury to the recurrent laryngeal nerve with voice changes, hematoma, and infection. Overall cure rates for carefully selected cases of sporadic primary hyperparathyroidism are high, with low recurrence in experienced hands.