Our Summary

Primary hyperparathyroidism is a disease where too much parathyroid hormone is produced from one or more of the parathyroid glands in the neck. The only cure is through surgery. Traditionally, a thorough exploration of all four glands in the neck was done. However, advances in imaging technology has made it possible to pinpoint the specific glands affected, allowing for less invasive surgery.

There are two surgical methods: minimally invasive parathyroidectomy (MIP) and bilateral neck exploration (BNE). Both have their pros and cons. However, the benefits of MIP, such as less tissue damage and quicker recovery, often outweigh those of BNE. As a result, many surgeons now prefer MIP over BNE.

FAQs

  1. What is primary hyperparathyroidism and how is it treated?
  2. What are the advantages and disadvantages of minimally invasive parathyroidectomy (MIP) compared to bilateral neck exploration (BNE)?
  3. Has minimally invasive parathyroidectomy (MIP) replaced bilateral neck exploration (BNE) as the preferred surgical treatment for primary hyperparathyroidism?

Doctor’s Tip

After a parathyroidectomy, it is important to follow up with your doctor regularly to monitor your calcium levels and ensure proper healing. Be sure to take any prescribed medications as directed and follow a healthy diet to support your recovery. If you experience any symptoms such as numbness, tingling, muscle cramps, or confusion, contact your doctor immediately.

Suitable For

Patients who are typically recommended for parathyroidectomy include those with primary hyperparathyroidism who have symptoms such as hypercalcemia, kidney stones, osteoporosis, fatigue, and muscle weakness. Patients with severe symptoms or complications from hyperparathyroidism may also be recommended for surgery. Additionally, patients with a confirmed diagnosis of a parathyroid adenoma or hyperplasia on imaging studies may also be candidates for parathyroidectomy. Minimally invasive parathyroidectomy may be recommended for patients who are suitable candidates for a focused approach and who have a localized adenoma that can be easily identified and removed.

Timeline

Before parathyroidectomy:

  • Patient presents with symptoms of primary hyperparathyroidism, such as fatigue, weakness, bone pain, kidney stones, and gastrointestinal issues.
  • Blood tests reveal elevated levels of calcium and parathyroid hormone.
  • Imaging studies, such as ultrasound or sestamibi scan, are performed to locate the abnormal parathyroid gland(s).
  • Patient undergoes pre-operative evaluation and clearance for surgery.

After parathyroidectomy:

  • Patient undergoes minimally invasive parathyroidectomy (MIP) or bilateral neck exploration (BNE) surgery to remove the abnormal parathyroid gland(s).
  • Intraoperative parathyroid hormone (PTH) monitoring is used to confirm successful removal of the abnormal gland(s).
  • Post-operatively, patient may experience temporary hypocalcemia due to the remaining parathyroid glands needing time to adjust to the lower levels of PTH.
  • Patient is monitored for signs of recurrent or persistent hyperparathyroidism, such as elevated calcium levels.
  • Patient may experience improvement or resolution of symptoms related to primary hyperparathyroidism.

What to Ask Your Doctor

  1. What is the reason for recommending a parathyroidectomy in my case?

  2. What are the potential risks and complications associated with the surgery?

  3. How experienced are you in performing parathyroidectomy procedures?

  4. What type of parathyroidectomy procedure do you recommend for me - minimally invasive parathyroidectomy (MIP) or bilateral neck exploration (BNE)?

  5. What is the success rate of the procedure in terms of curing primary hyperparathyroidism?

  6. What is the recovery process like after the surgery?

  7. Will I need to take any medication or follow a specific diet after the surgery?

  8. How long will it take for me to fully recover and resume normal activities?

  9. Are there any long-term effects or complications that I should be aware of?

  10. Are there any alternative treatment options to consider before proceeding with surgery?

Reference

Authors: Laird AM, Libutti SK. Journal: Surg Oncol Clin N Am. 2016 Jan;25(1):103-18. doi: 10.1016/j.soc.2015.08.012. PMID: 26610777