Parathyroidectomy (cont.)

When is a parathyroidectomy necessary and how is it performed?

Parathyroidectomy is necessary when calcium levels are elevated, if there is a complication of hyperparathyroidism, or if a patient is relatively young. During a parathyroidectomy, the surgeon delicately removes one or more of the tiny parathyroid glands. In some situations, both sides of the neck are explored, while in other cases a direct approach is made through a small incision (referred to as a minimally invasive parathyroidectomy). Tests such as a high-resolution ultrasound or a nuclear medicine scan (called a sestamibi scan) help to direct the approach preoperatively or intra-operatively by identifying the location of the overactive, enlarged gland. In rare situations, the offending gland cannot be found. (A portion of a gland also may be transplanted to another site in the neck or the arm to preserve parathyroid function.)

Whereas preoperative tests help to identify hyperparathyroidism and to direct the surgical approach, PTH levels obtained during parathyroidectiomy help to guarantee the successful resection of the abnormal gland by demonstrating a return of the PTH levels to normal after the suspected parathyroid adenoma is removed. Using this method, a PTH determination is obtained immediately prior to the resection and compared to a PTH determination done ten minutes after the resection.

What are the risks of parathyroidectomy?

The anatomy of the parathyroid glands is complicated by two important structures: the recurrent laryngeal nerve and the thyroid gland. The recurrent laryngeal nerve is a very important nerve that runs very close to or through the thyroid gland next to the parathyroid glands. This nerve controls movement of the vocal cord on that side of the larynx , and damage to the nerve can weaken or paralyze the vocal cord. Weakness or paralysis of one vocal cord causes a breathy weak voice, and difficulty swallowing thin liquids. Weakness or paralysis of both vocal cords causes difficulty breathing. In most situations, a special breathing tube is used that rests in the larynx (voice box) between the vocal cords and is designed to allow for the continued monitoring of their function. In rare situations, the parathyroid adenoma is found within the thyroid gland, and it is necessary to remove the thyroid gland as well. The main goal of the parathyroidectomy operation is to remove the offending gland(s) while protecting the remaining normal parathyroid glands as well as the recurrent laryngeal nerves and the thyroid gland.

Surgery may be unsuccessful, that is, the hyperparathyroidism may not be cured and there may be complications of the surgery. Because individuals differ in their response to surgery, their reaction to the anesthetic and their healing following surgery, there can be no guarantee made as to the results or the lack of complications. Furthermore, the outcome of surgery may depend on preexisting or concurrent medical conditions.

Source: MedicineNet.com
http://www.medicinenet.com/parathyroidectomy/article.htm