What is parathyroidectomy
Parathyroidectomy is a surgical procedure that removes a diseased parathyroid gland. People usually have four tiny parathyroid glands located behind the thyroid gland in the neck. Although they are small, they have an important role: they secrete parathyroid hormone, which regulates the level of calcium and phosphorus in the blood and affects bone health.
When one or more glands begin to work excessively, we speak of hyperparathyroidism. The most common cause is a benign tumor, a so-called adenoma, but the enlargement can also be caused by the enlargement of several glands or, more rarely, a malignant process. Excessive secretion of parathyroid hormone leads to raised calcium in the blood, which over time damages various organs.
Surgery removes the gland that is the cause of the disorder, thereby returning parathyroid hormone secretion to normal. With a typical adenoma it is enough to remove only that one gland, while when several glands are involved the approach is adapted to the findings. The surgeon makes the decision on the extent of the operation based on imaging and laboratory findings.
Parathyroidectomy belongs to the field of endocrine surgery and requires precise work in the sensitive neck area, near the vocal cords and the thyroid gland. That is why it is important that it is performed by a team experienced in this type of operation.
When parathyroidectomy is indicated
Surgery is considered in confirmed hyperparathyroidism with raised calcium and parathyroid hormone, especially when there are symptoms or signs of organ damage. In some patients the disease is discovered by chance, from a laboratory finding, even before any symptoms appear.
The doctor assesses whether surgery is needed based on the calcium level, the state of the bones and kidneys, the patient's age and the presence of symptoms. With pronounced symptoms or complications, removing the diseased gland is the most effective way of treatment.
- A persistently raised calcium level in the blood
- Raised parathyroid hormone with a kidney stone or reduced kidney function
- Reduced bone density and a tendency to fractures
- Pain in the bones and muscles
- Fatigue, weariness and weakness
- Frequent urination and increased thirst
- Nausea, loss of appetite or constipation
- Mood disorders, irritability and difficulty concentrating
How parathyroidectomy is performed
Before the operation the diseased gland is localized with a neck ultrasound and additional imaging, so the surgeon knows exactly where the change is. Precise localization allows a targeted, minimal approach in most patients.
With a classic adenoma, minimally invasive parathyroidectomy is increasingly used, through a small incision on the neck, removing only the diseased gland. When several glands are involved or the localization is not clear-cut, a wider neck exploration is done to examine all the glands.
During the operation special care is taken of the recurrent laryngeal nerve, which controls the vocal cords, as well as of the healthy parathyroid and thyroid glands. In some cases parathyroid hormone is measured during the operation itself to confirm that the diseased gland has been successfully removed.
Preparation
Preparation begins with a detailed examination, laboratory tests and imaging that confirm the diagnosis and localize the diseased gland. The surgeon and anesthesiologist assess the general condition and any accompanying illnesses, so the operation proceeds safely.
It is important that you present the doctor with the complete picture of your health, including the medications you take. Some medications, especially those that affect blood clotting, may require adjustment before the procedure.
- Tell the doctor about all medications you take, including blood thinners and dietary supplements
- Report allergies, previous surgeries and problems with anesthesia
- State chronic illnesses of the heart, kidneys, thyroid and diabetes
- Follow the instructions on fasting before surgery
- Arrange accompaniment for the return home after the procedure
- Bring all previous findings and images on the day of surgery
The procedure, anesthesia and duration
Parathyroidectomy is most often performed under general anesthesia, so the patient sleeps through the procedure and feels no pain. In carefully selected patients, with a targeted minimal approach, other forms of anesthesia are also possible, which the anesthesiologist decides.
The duration of the operation depends on whether one gland is removed or a wider neck exploration is needed. Targeted procedures for a clearly localized adenoma usually take a shorter time, while examining all the glands lengthens the operation.
After the procedure the patient wakes in a monitoring room, where the basic parameters are watched. The calcium level is also checked after the operation, because the body is given time for its metabolism to return to balance.
Recovery
Recovery after parathyroidectomy is, for most patients, quick, especially when a minimal approach has been used. Mild pain and a feeling of tightness in the area of the incision are usual and are well controlled with prescribed therapy. The incision on the neck is usually small and becomes less noticeable over time.
In the first days a temporary drop in calcium may occur while the remaining glands adjust, so numbness or tingling around the lips and in the fingers is possible. That is why the doctor monitors calcium and, if needed, introduces additional therapy of calcium and vitamin D. The return to usual activities is gradual and aligned with the team's recommendations.
In some patients the symptoms that were a consequence of raised calcium, such as fatigue and weariness, gradually subside as the metabolism returns to balance. Regular follow-ups in the first period help confirm that the calcium value is stable and that the therapy is adapted to your needs.
- Keep to the schedule of follow-ups and blood draws for calcium
- Take the prescribed therapy of calcium and vitamin D as instructed
- Report to the doctor numbness, cramps or tingling around the lips and in the fingers
- Keep the wound clean and dry according to the instructions received
- Avoid strenuous physical work in the first days after the procedure
- Take in enough fluids and follow the dietary advice
Possible risks
Parathyroidectomy is today a routine operation, but like any surgical procedure it carries certain risks. With an experienced team and careful preparation serious complications are rare, and most transient discomforts subside during recovery.
Before the operation the surgeon explains in detail the possible risks in relation to your specific condition, so you enter surgery fully informed.
- A temporary or, rarely, permanent drop in blood calcium
- A transient or, exceptionally rarely, permanent voice change due to irritation of the vocal cord nerve
- Bleeding or the formation of a hematoma in the neck area
- Wound infection
- The possibility that symptoms persist if there is an additional diseased gland
- The usual risks related to general anesthesia
Why Medical Time
At Medical Time in Belgrade we approach parathyroidectomy as a team, from precise diagnostics and localization of the diseased gland to the operation itself and monitoring of recovery. Our goal is a safe procedure, a tidy aesthetic result and clear communication at every step.
- An experienced surgical team in the field of endocrine surgery
- Precise diagnostics and localization of the gland before the operation
- A minimally invasive approach in suitable patients
- Careful monitoring of calcium before and after the operation
- Complete support through preparation, the procedure and follow-ups
- A clear and understandable conversation about the course and expectations
Price — parathyroidectomy
The price of parathyroidectomy depends on the extent of the operation and on whether one gland is removed or a wider neck exploration is needed. The final estimate is also affected by the type of anesthesia, the diagnostics needed before the procedure, the laboratory calcium checks and the length of monitoring after the operation.
Every patient is unique, so the precise price and treatment plan are determined after an examination and review of the findings. At the consultation you receive a clear picture of the proposed procedure and everything it involves.
- Consultation and surgeon's examination
- Preoperative diagnostics and localization of the gland
- Surgery with anesthesia
- Calcium checks and monitoring of recovery
For an individual estimate and an appointment, call 062-399-888.
Frequently asked questions
It is a condition in which the parathyroid gland secretes too much parathyroid hormone, which raises the calcium level in the blood. Over time this can damage the bones and kidneys, so in pronounced cases removal of the diseased gland is advised.
No. With a typical adenoma only the diseased gland is removed, and the healthy ones are preserved. When several glands are involved, the extent of the operation is adapted to the findings, and the decision is made by the surgeon.
With a minimally invasive approach the incision is small and usually becomes less noticeable over time. The final appearance depends on the approach and the individual characteristics of the skin.
After the diseased gland is removed the calcium level may temporarily drop while the remaining glands adjust. That is why the doctor monitors calcium and, if needed, introduces additional therapy.
During the operation special care is taken of the nerve that controls the vocal cords. Voice changes are rare and most often transient, and the surgeon takes every measure to avoid them.
For most patients recovery is quick, with a gradual return to usual activities. The exact course depends on the extent of the operation and your general condition, about which the team advises you in detail.
You can book a consultation at Medical Time in Belgrade by calling 062-399-888. At the examination we assess the findings and propose a further plan.