Our Summary

This research paper is essentially a guide for performing specific types of surgery on the parathyroid glands, which are tiny glands located in your neck, producing a hormone that regulates calcium levels in your body. The two surgical procedures detailed are targeted parathyroidectomy (removal of one or more parathyroid glands) and four-gland exploration (investigation of all four parathyroid glands). This guide also includes practical advice and tips on the anatomy and approach to these procedures, as well as other factors to consider.

FAQs

  1. What is the step-by-step approach to targeted parathyroidectomy and 4 gland exploration?
  2. What are some important considerations regarding anatomy and approach in a parathyroidectomy?
  3. What does the term “subtotal parathyroidectomy” refer to?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to follow post-operative care instructions closely, including staying well-hydrated, getting plenty of rest, and avoiding strenuous activities until cleared by your healthcare provider. It is also important to attend all follow-up appointments and have regular blood tests to monitor calcium levels and ensure proper healing.

Suitable For

Patients who are typically recommended for parathyroidectomy are those with primary hyperparathyroidism, secondary hyperparathyroidism, tertiary hyperparathyroidism, and parathyroid cancer. These patients may present with symptoms such as fatigue, weakness, bone pain, kidney stones, and high levels of calcium in the blood. They may also have imaging studies that show enlarged or abnormal parathyroid glands. In some cases, patients may not have symptoms but have elevated levels of parathyroid hormone (PTH) and calcium in the blood, which may warrant surgical intervention. Ultimately, the decision to undergo parathyroidectomy is made on a case-by-case basis by a multidisciplinary team of healthcare providers including endocrinologists, surgeons, and radiologists.

Timeline

Before Parathyroidectomy:

  1. Initial consultation: Patient presents with symptoms of hyperparathyroidism, such as fatigue, weakness, kidney stones, and bone pain. Blood tests reveal elevated levels of parathyroid hormone (PTH) and calcium.
  2. Imaging studies: Scans, such as ultrasound, sestamibi scan, or CT scan, are performed to locate the abnormal parathyroid gland(s).
  3. Pre-operative evaluation: Patient undergoes a thorough evaluation to assess overall health and determine if they are a candidate for surgery.

After Parathyroidectomy:

  1. Surgical procedure: The surgeon locates and removes the abnormal parathyroid gland(s) through a small incision in the neck. In cases of hyperplasia or multiple adenomas, a four-gland exploration may be performed.
  2. Recovery: Patient is monitored in the hospital for a few days to ensure proper healing and management of calcium levels.
  3. Follow-up: Patient will have regular follow-up appointments to monitor PTH and calcium levels and assess for any recurrence of hyperparathyroidism.
  4. Long-term management: Patient may need to take calcium and vitamin D supplements to maintain normal calcium levels and prevent complications of hypocalcemia.

What to Ask Your Doctor

  1. Why do I need a parathyroidectomy?
  2. What are the potential risks and complications associated with the surgery?
  3. What type of anesthesia will be used for the procedure?
  4. How long will the surgery take and what is the expected recovery time?
  5. Will I need to take any medication or follow a special diet after the surgery?
  6. What are the chances of the surgery being successful in resolving my parathyroid condition?
  7. Will I need any follow-up appointments or tests after the surgery?
  8. How will the surgery affect my calcium levels and overall health in the long term?
  9. Are there any alternative treatments or procedures that I should consider before undergoing a parathyroidectomy?
  10. Can you provide me with more information about the specific technique you will use for the parathyroidectomy and the experience you have performing this procedure?

Reference

Authors: Colaianni CA, Shindo M. Journal: Otolaryngol Clin North Am. 2024 Feb;57(1):117-123. doi: 10.1016/j.otc.2023.08.004. Epub 2023 Sep 14. PMID: 37714781