Name of the Procedure:

Parathyroidectomy (Exploration of Parathyroids)

Summary

Parathyroidectomy is a surgical procedure to remove one or more of the parathyroid glands. The parathyroid glands are small glands located behind the thyroid gland in the neck. This procedure is often necessary to address issues related to abnormal parathyroid hormone levels that affect calcium balance in the body.

Purpose

Parathyroidectomy is performed to treat conditions such as primary hyperparathyroidism, where one or more of the parathyroid glands become overactive, leading to elevated calcium levels in the blood. The goals are to normalize calcium levels and alleviate symptoms like fatigue, depression, kidney stones, and bone pain.

Indications

• Elevated blood calcium levels
• Symptoms of hyperparathyroidism (e.g., fatigue, bone pain)
• Recurrent kidney stones
• Osteoporosis or bone fractures
• Vitamin D deficiency
• Failed medical management of hyperparathyroidism

Preparation

• Fasting for at least 8 hours before the procedure
• Discontinuing certain medications as directed by the healthcare provider (e.g., blood thinners)
• Preoperative blood tests and imaging studies (e.g., ultrasound, sestamibi scan) to locate the overactive gland(s)

Procedure Description

1. Anesthesia is administered (general or local with sedation).
2. A small incision is made in the neck to access the parathyroid glands.
3. The surgeon identifies and evaluates each gland, removing the ones that are overactive.
4. Sometimes, intraoperative PTH (parathyroid hormone) monitoring is used to ensure successful removal.
5. The incision is closed with sutures.

Duration

The procedure typically takes 1-3 hours.

Setting

Parathyroidectomy is usually performed in a hospital or surgical center.

Personnel

• Surgeons (typically a specialized endocrine or head and neck surgeon)
• Anesthesiologists
• Operating room nurses
• Surgical assistants

Risks and Complications

• Bleeding
• Infection
• Damage to surrounding structures (e.g., thyroid, vocal cords)
• Hypocalcemia (low calcium levels)
• Scarring
• Persistent or recurrent hyperparathyroidism

Benefits

• Normalization of blood calcium levels
• Resolution or improvement of symptoms associated with hyperparathyroidism
• Prevention of complications like kidney stones and bone fractures

Recovery

• Hospital stay of 1-2 days, with discharge instructions for home care
• Pain management with prescribed medications
• Monitoring of calcium levels post-surgery
• Avoiding strenuous activities for a few weeks
• Follow-up appointments to assess recovery and calcium levels

Alternatives

• Medical management with medications (e.g., bisphosphonates)
• Monitoring without immediate treatment if asymptomatic (watchful waiting)
• Minimally invasive parathyroid surgery, if applicable

Patient Experience

During the procedure, the patient will be asleep or sedated. Postoperatively, there may be some pain and discomfort in the neck, managed by pain medications. Patients may experience temporary voice changes or soreness. Most individuals feel relief from symptoms within weeks following the surgery. Regular follow-up is necessary to monitor calcium levels and overall health.