Parathyroid glands are located in the neck just behind the thyroid gland. There are typically four parathyroid glands that regulate blood calcium levels. Hypoparathyroidism is a rare but serious condition that can result after the removal of all four parathyroid glands. It may happen during neck or thyroid surgery when the pea-shaped gland is resected by mistake. In this condition, the blood calcium levels drop suddenly and may cause dangerous heart rhythm irregularities and seizures. The condition happens due to the extremely low blood calcium level and needs immediate correction of the calcium levels.
The one or more parathyroid glands may be surgically removed in case of tumors of the glands. The removal of one or two parathyroid glands results in a condition called hypocalcemic tetany. It starts with a tingling sensation or numbness in your fingers or toes. There may be spasms of the muscles of the hands, causing wrist drop. There may be twitching of the facial muscles. In serious cases, there may be laryngeal muscle spasm as well, resulting in noisy breathing.
Why is parathyroidectomy performed?
Your doctor may recommend the removal of the parathyroid gland if the gland is producing too much parathyroid hormone (PTH), which is a condition known as hyperparathyroidism. This can happen due to a noncancerous (benign) tumor, known as parathyroid adenoma, or a malignant tumor or cancer of the parathyroid.
Hyperparathyroidism results in hypercalcemia, whose signs and symptoms include:
What are the different types of parathyroidectomy?
There are three types of surgery by which your parathyroid gland may be removed. The choice of surgery depends on the location of the tumor or the affected part of the parathyroid.
Types of surgery include:
- Traditional parathyroidectomy: The surgeon makes incisions on both sides of the neck to locate and remove the thyroid.
Other approaches are known as minimally invasive surgeries that include:
- Radio-guided parathyroidectomy: You will receive a shot of radioactive material in your neck. This helps highlight the diseased areas of the parathyroid gland. The doctor inserts a probe in your neck to guide them to the diseased portion. A small, single incision (1-2 inch) on that side of the neck is made accordingly, and through this, the parathyroid gland is removed.
- Video-assisted parathyroidectomy: Your surgeon will make two small cuts on your neck. One is for instruments and the other is for a camera. The camera helps to view the area and the instruments will remove the diseased glands.
- Endoscopic parathyroidectomy: Your surgeon will make two or three small cuts in the front of your neck and one cut (less than 2 inch) above the top of your collarbone. A long tube-like camera (endoscope) is introduced through one cut and surgical instruments to remove the parathyroid are inserted through the other two-three smaller cuts.
Minimally invasive procedures reduce visible scarring, pain, and recovery time.
Transoral parathyroidectomy: This is a novel technique in which the parathyroid gland is removed through your mouth.
What are the risks of parathyroidectomy?
Every surgery carries some risks. Parathyroidectomy is no exception. The possible complications of parathyroidectomy include:
- Damage to the recurrent laryngeal nerve: This is a rare but serious complication that can result in weakness or paralysis of the vocal cord or cords. You will experience a weak, breathy voice, and problems swallowing.
- Bleeding or hematoma (pooling of blood): This is a common risk in all surgeries. A blood transfusion may be necessary if excess blood is lost during surgery.
- Lifelong hypocalcemia: Damage to the healthy parathyroid glands while removing the diseased parathyroid gland may cause a permanent state of low blood calcium levels. You may have to take calcium supplements throughout your life.
- Injury to the thyroid gland: Since the parathyroid glands are located adjacent to the thyroid glands, the thyroid gland may get damaged while operating on them. If the doctor finds that the cancer of the parathyroid gland has extended to the thyroid gland, they may remove a part or whole of the thyroid as well.