The parathyroid glands are 4 to 6 usually endocrine glands. They are anatomically located at the back of the neck, behind the thyroid gland, at the top and bottom of each lobe. Their role is to regulate the balance of calcium in the blood and this is done through the production of a hormone called parathormone (PTH). The parathyroid glands while they are in close proximity to the thyroid gland however their function is completely different.
The balance of calcium in the body is of paramount importance. It contributes to the function of the nervous, muscular and skeletal system of the body. It is known that brain cells communicate with each other thanks to calcium. The contraction and movement of the muscles is thanks to this but also the strength and endurance of the bones of our skeleton depends on calcium.
The most common disease, of course, is hyperparathyroidism, in which parathyroid hormone (PTH) is over-controlled. This results in a dangerous increase in calcium (Ca) in the blood. Usually (90%) one gland has a tumor (adenoma), while the remaining 10% may have two or three parathyroid glands (hyperplasia).
The symptoms are: constant fatigue, weakness, dizziness, headaches, memory disorder, hair loss, concentration disorder, depression. Patients may also develop arrhythmia, hypertension, nephrolithiasis, and osteoporosis leading to fractures. Some patients do not feel obvious symptoms and sometimes they go to the family doctor. This is how patients learn and live with them, with the result that the quality of both their life and their environment is very negatively affected.
The diagnosis is based on a thorough clinical examination but also on blood tests (Ca, PTH), ultrasound and scintigraphy with sestamibi.
Surgical treatment is the removal of a gland when the problem is located in it. The removal is done after the others are examined intraoperatively and found to be normal. If more parathyroid glands are affected then more are removed, depending on the patient’s problem.
Surgery of the parathyroid and thyroid glands requires delicate manipulations and that is why we say that they require demanding surgery. The surgeon should be familiar with the cervix, they do not need large incisions that are unfortunately made in some patients. On the contrary, it takes a lot of experience and the incision to be very small. The main difficulty is to locate the gland and this requires the ability, experience and specialization of the surgeon.
The patient does not need to be hospitalized for even 24 hours, speaks immediately, mobilizes and feeds after the first hours of surgery.
Pathology of the parathyroid glands
Parathyroid glands – indications for surgery
Surgery (parathyroidectomy) is generally indicated if the parathyroid glands are overactive. This is due to a benign tumor of one (parathyroid adenoma), hyperactivity or the development of more glands (diffuse hyperplasia). Rarely it may be due to a malignant tumor of one of the glands (parathyroid cancer).
Parathyroid hyperactivity may be related to bone loss of calcium (osteoporosis). Other symptoms may include generalized fatigue, lethargy, kidney stones, stomach ulcers, joint pain and soreness, and constipation.
Parathyroid glands and cancer
Parathyroid cancer is extremely rare (almost 1 in 2 million). Cases of parathyroid cancer make up less than 1% of the total number of patients with primary hyperparathyroidism. Patients are usually over 30 years old and it occurs equally in men and women. Patients with parathyroid cancer typically have very high calcium levels (greater than 14 mg / dL). They also have very high levels of parathyroid hormone (PTH) (more than five times the upper limit of normal, usually greater than 300 pg / mL or more).
About half of patients with parathyroid cancer will develop a hard mass in the throat. Your doctor may not be able to tell if it is cancer. Parathyroid cancer may not be diagnosed preoperatively and may be suspected by the surgeon from the findings in the operating room. The best chance of treating parathyroid cancer is the early diagnosis of the disease and its immediate removal.
By the time he is diagnosed, parathyroid cancer may have developed in surrounding organs, such as the thyroid. The best treatment for parathyroid cancer is to remove the parathyroid cancer along with the thyroid lobe on the same side. If the cancer recurs, reoperation may be needed to remove the recurrence. Parathyroid cancer does not respond well to chemotherapy and radiation. Fortunately, parathyroid cancer often develops slowly and patients can be re-operated for relapse.
Of course, any surgery increases the risk of complications, but also the chance of a new reoperation. For patients who are not eligible for surgery, other treatments such as those with calcium-lowering drugs can help improve symptoms and prolong life.
How is parathyroid surgery performed?
Parathyroidectomy is usually performed under general anesthesia, although this can be done under local anesthesia, in special cases, if required. The incision is made in the front of the neck, 2 to 3 cm above the key. The underlying muscles open to expose the thyroid. The surgeon prepares and mobilizes the thyroid gland and then locates and identifies the parathyroid glands.
It then removes one or more depending on each case. Great care is taken not to injure the nerves that control the voice (laryngeal nerves). The muscles are then sutured, followed by the suturing of the skin.
What are the risks and complications of surgery?
Most surgeries today are safe, but any operation has risks such as reactions to anesthesia, respiratory infections, wound infection. In the parathyroid glands, there are special risks associated with their surgery:
- Postoperative bleeding can cause swelling in the throat and difficulty breathing due to pressure on the trachea. Surgery is required to remove blood clots.
- Injury to the laryngeal nerves can cause hoarseness in the voice. This is usually temporary, but can be permanent in up to 1 to 2% of cases. It can be improved with speech therapy or surgery for the vocal cords. Whether you are a singer or a public speaker, any thyroid / parathyroid surgery can cause subtle, long-term changes in your voice.
- Injury to other parathyroid glands can cause a drop in the level of calcium in the blood. It is treated with calcium and vitamin D tablets and usually comes back in a few weeks.
- A keloid, or overgrowth of scar tissue, can be formed in any surgical scar.
- Even in the hands of most specialists, up to 5% of parathyroid tumors can not be found during surgery. Then calcium will remain high (persistent hyperparathyroidism). Sometimes after successful surgery, one of the other remaining parathyroid cells may become hyperactive. This can cause an increase in calcium (recurrent hyperparathyroidism).
- It is well known and understood that in experienced hands the occurrence of complications is minimized.