Minimally Invasive Parathyroid Surgery
The parathyroid glands are four small glands located behind the thyroid that regulate the calcium level in the body. By controlling the amount of calcium in the body, the parathyroid glands also control the strength and density of the bones. This also helps regulate the function of the nervous and muscular systems.
Although similar in name and location to the thyroid gland, the two are not related in function. The parathyroid glands can, however, be affected by conditions similar to the thyroid gland and other endocrine system structures by producing too much or too little parathyroid hormones.
The most common condition of the parathyroid glands is hyperparathyroidism, or overactivity of the parathyroid gland. This involves an overproduction of parathyroid hormone (PTH) regardless of the amount of calcium in the blood. Although not a cancerous condition, hyperparathyroidism is often caused by a tumor on the parathyroid gland, known as an adenoma, which enlarges the specific gland and forces it to continuously secrete PTH. Most people with hyperparathyroidism have only one enlarged gland, but others can have all four affected by the condition.
A blood test can be done to see if calcium and parathyroid hormone levels in the blood are too high. Because high PTH levels can cause bones to weaken from lost calcium, a measurement of bone density helps assess the risk of fractures. Abdominal images may reveal the presence of kidney stones, and a 24-hour urine collection may provide information on kidney damage and the risk of stone formation.
Hyperparathyroidism is known as a condition of “moans, groans, stones and bones.” Many people do not realize their symptoms were related to the condition until undergoing treatment and feeling much better as a result, while others really may not experience any symptoms. Common symptoms of hyperparathyroidism can include:
- Increased thirst and urination
- Kidney stones
- Abdominal pain
Treatment for this hyperparathyroidism depends on the symptoms and severity of the condition. Your doctor may recommend just waiting and monitoring the condition for mild cases, while those with symptoms may benefit from medication or hormone replacement therapy. Surgery is considered the most effective treatment for hyperparathyroidism and removes one or more parathyroid glands. While this procedure once required a long incision and general anesthesia, it can now be performed through minimally invasive techniques to reduce the risk of infection and shorten recovery time.
Although hyperparathyroidism is not a serious condition, it can lead to complications such as osteoporosis, peptic ulcers and high blood pressure. Your doctor can help you decide which treatment option is best for you in order to relieve symptoms and reduce the risk of future damage.
Although medication is available to treat hyperparathyroidism, surgery is most often recommended and is the only cure. Surgery has a 95 percent success rate.
Surgical removal of one or more parathyroid glands is called a parathyroidectomy. During the operation, you will be given either a general or local anesthetic. Your doctor will make a small incision in your neck and remove the gland. Your particular problem will determine how many of the parathyroid glands need to be removed. Some parathyroid tissue must be left in place to help prevent hypoparathyroidism (decreased parathyroid activity).
If more than one parathyroid gland has to be removed, then the procedure will involve general anesthesia and may take up to three hours. Patients are typically hospitalized overnight and can return home the next morning.
However, in most cases of hyperparathyroidism, only one gland has to be removed and a less invasive procedure called minimally-invasive radio-guided parathyroid (MIRP) surgery can be performed. MIRP surgery only involves a local anesthetic, requires a much smaller incision and has a very high success rate. The operation usually takes less than 30 minutes and you may return home within one to two hours. You will be able to return to your normal daily activities after just one day.
Risks and Complications
Complications of parathyroid surgery are more common in the traditional procedure than in the MIRP procedure, but both procedures are generally safe and successful. Fewer than one percent of patients undergoing surgery experience damage to the nerves controlling the vocal cords, which can affect speech. Patients requiring more extensive surgery could develop hypoparathyroidism, resulting in low calcium levels, which may require treatment with calcium or vitamin D.