The parathyroid glands are four small endocrine glands about 3-4 mm in diameter that are located in the neck, attached to the thyroid, another important endocrine gland whose function is completely independent of that of the parathyroids.
The function of the parathyroids is to maintain a constant calcium concentration in the blood (8.6-10.2 mg/dl).
What are the parathyroids like?
The parathyroids are one of the smallest glands in our body. There are four of them, two on each side of the neck, and each weighs no more than 50 milligrams. Their anatomy is somewhat variable so the surgeon must be experienced in knowing how to look for them and locate them in the right place.
Indication for surgery
As explained by Dr. Prof. Prof. Mauro Valentini, specialist in General and Digestive System Surgery, expert in Thyroid and Endocrine Surgery and Obesity Surgery, the most common cause for a patient to need parathyroid gland surgery is primary hyperparathyroidism.
Hyperparathyroidism is a disease in which one or more of the parathyroid glands increase in size (adenoma) and produce an increase of calcium in the blood (hypercalcemia). This pathology can appear at any age, but it is more common in women between 45 and 65 years old and its consequences can derive, in the most severe cases, to kidney stones, osteoporosis, digestive disorders and general fatigue and tiredness.
Parathyroid operation
Before the operation, several tests are performed to determine in which of the glands the adenoma to be removed is located. If the localization tests give a good result, 60-70% of the cases, the surgeon will remove only this gland. If, on the contrary, the adenoma is not found in the preoperative X-rays, the surgeon will look for the four glands until he finds which one to remove. In 90% of cases it is only one gland that needs to be operated on.
How is the operation performed?
If it is a single gland that must be removed, the surgeon will make an incision in the front and side of the neck 2-3 cm above it and remove it without touching any other anatomical structure. This operation is called selective parathyroidectomy and may be performed in 6 or 7 out of 10 patients with PTH. If it is necessary to look for all four glands or to remove three and a half glands the incision will be central and a little larger in order to be able to operate on both sides of the neck.
As for the postoperative period, parathyroid operations can be performed with a short admission of 1 to 3 days depending on the severity of the disease. After the operation, the calcium in the blood will normalize and may even be lower than normal, so your surgeon may recommend that you take calcium pills for a short period of time.
Possible complications of the procedure: dysphonia or excessive lowering of calcium levels
Since the nerves that move the vocal cords are very close to the parathyroids, to preserve them it is necessary to separate them from the glands to be removed. In 5% of cases this can produce a transient aphonia which disappears within two to ten weeks.
Rarely, in 1-2% of cases, usually in complicated operations in previously operated patients, this aphonia is definitive because the recurrent nerve may have been injured.
The calcium depletion that occurs after removal of the diseased parathyroid is usually mild, but can sometimes cause symptoms such as tingling of the lips and tips of the fingers and toes, or muscle cramps. If this happens to you, you should contact us to advise you to go to the emergency room.
When can I return to my usual activities?
After discharge from the hospital, you should gradually return to your normal activities in a progressive manner. The doctor advises you not to excessively limit your neck movements for fear of complications from the wound since immobility may cause neck pain and stiffness.
What will the scar of the operation look like?
The small lateral incisions used in selective parathyroidectomy are closed with plastic surgery techniques and are practically invisible approximately 6 months after the operation.
The central scars of about 3-4 cm, are somewhat more visible, but also go virtually unnoticed in the year of the intervention.
The final aesthetic result cannot be judged until after at least six months and it is advisable to use silicone dressing to improve the final result of the scar and to protect from direct sun exposure during the first months.