What can I Expect During Hyperparathyroidism Surgery?

Hyperparathyroidism occurs when one or more of the four parathyroid glands becomes overactive and produces excess parathyroid hormone (PTH). Treatment is hyperparathyroidism surgery to remove all of the overactive parathyroid glands. Conventional hyperparathyroidism surgery may be used, but a technique known as minimally invasive radioguided parathyroid surgery (MIRP) is often preferred.

The four parathyroid glands are at the base of the neck, near the chest, just under the thyroid glands. Two parathyroid glands reside on the left side of the neck and the other two are on the right side. Parathyroid glands produce PTH, which helps to maintain healthy levels of blood calcium and phosphorus. A healthy parathyroid gland is about the size of a grain of rice, while an overactive parathyroid gland will become enlarged to about the size of an almond. The cause of hyperparathyroidism is unknown.

In conventional hyperparathyroidism surgery, performed under general anesthesia, an endocrinologist will make a 5- to 7-inch (about 13- to 18-cm) incision in the neck. All of the parathyroid glands are examined and the enlarged, overactive ones are removed. If all four glands are enlarged, then a small portion of one of the glands is left intact to continue producing PTH. This surgery usually last from two to six hours and requires a hospital stay of one to three days.

Minimally invasive radioguided parathyroid surgery has greatly improved surgical treatment for hyperparathyroidism. In this procedure, a sestamibi scan is used to radioactively label the overactive parathyroid gland prior to surgery. During a sestamibi scan, a safe, radioactively tagged sestamibi protein is injected into the blood, where it accumulates at a higher rate in the overactive parathyroid gland than the healthy parathyroid glands. All of the parathyroid glands are reviewed using a camera that detects radiation, and the exact location of the malfunctioning and radioactive parathyroid gland is identified before the surgery.

The location of the overactive parathyroid gland is known ahead of time with MIRP, so only a 1-inch (2.5-cm) incision is necessary to remove the malfunctioning gland. A handheld radioactive probe is placed inside the incision to be certain that the correct parathyroid gland has been located. The gland is then removed, and the area is checked again with the probe to be certain that all of the radioactive material has been extracted.

MIRP is done using a sedative and local anesthesia. This form of hyperparathyroidism surgery usually takes one hour, and no hospital stay is required. A small bandage is placed over the incision for one week.

People with hyperparathyroidism often will not have symptoms and the problem will be discovered through a routine blood test for calcium levels. In some cases, however, symptoms may include fatigue, depression, constipation, nausea and vomiting, memory impairment, and confusion. Hyperparathyroidism is confirmed with a blood test for PTH and calcium.