Parathyroid Surgery
Specialist assessment and surgical treatment of primary hyperparathyroidism.
Primary hyperparathyroidism is commonly identified through an elevated blood calcium level.
PTH is elevated or inappropriately normal despite the high calcium.
The diagnosis is made with blood tests, not with a scan.
Parathyroidectomy is the only curative treatment.
What do the parathyroid glands do?
Most people have four parathyroid glands located behind the thyroid. Their role is to regulate the level of calcium in the blood through parathyroid hormone, or PTH.
In primary hyperparathyroidism, one or more glands produce too much PTH. This causes calcium to rise and can affect bones, kidneys and other parts of the body.
Possible effects
- Kidney stones
- Osteoporosis or loss of bone density
- Fatigue or reduced energy
- Difficulty concentrating or cognitive symptoms
- Abdominal or gastrointestinal symptoms
- Increased thirst or urination
- Sometimes no obvious symptoms at all
How is primary hyperparathyroidism diagnosed?
The diagnosis is biochemical. Blood tests come before localisation imaging.
Imaging comes after the diagnosis
Ultrasound, sestamibi and other scans do not diagnose primary hyperparathyroidism.
Their role is to help locate the abnormal gland or glands after the biochemical diagnosis has already been established.
- High-quality neck ultrasound
- Sestamibi SPECT/CT
- 4D CT in selected cases
- PET/CT in selected difficult cases
Imaging that does not localise an abnormal gland does not exclude primary hyperparathyroidism.
Who should consider surgery?
Patients with biochemically confirmed primary hyperparathyroidism who are medically fit for surgery should be considered for endocrine surgical assessment.
Surgery should not be restricted only to younger patients or patients whose calcium exceeds an arbitrary threshold.
Parathyroidectomy is the only treatment that can cure primary hyperparathyroidism.
Surgery may be particularly important when there is
- Kidney stones or renal complications
- Osteoporosis or reduced bone density
- Significant hypercalcaemia
- Symptoms attributable to hyperparathyroidism
- Younger age or long anticipated duration of disease
- Patient preference for definitive treatment
Focused or bilateral parathyroid surgery?
The operation is tailored to the biochemical diagnosis, localisation studies and the likelihood of single- or multi-gland disease.
Focused parathyroidectomy
When imaging convincingly localises a single abnormal gland, surgery can often be directed to that gland through a focused approach.
- Smaller targeted operation
- Short neck incision
- Appropriate for selected single-gland disease
Bilateral neck exploration
When localisation is unclear, multi-gland disease is suspected, or the clinical situation warrants it, all four glands may need to be assessed.
- Useful when imaging is discordant or non-localising
- Allows assessment for multi-gland disease
- Still performed through a relatively small neck incision
Calcium and PTH after surgery
Calcium and PTH levels fall after successful parathyroid surgery.
Calcium can sometimes fall temporarily below the normal range, particularly as the bones begin taking up calcium again. Calcium and PTH are checked after surgery, and calcium supplementation is adjusted according to blood results and symptoms.
Discuss your parathyroid condition
Assessment begins with confirming the biochemical diagnosis, then determining the most appropriate localisation and surgical approach.