If you look carefully at the picture above you can see a normal parathyroid gland. The left thyroid lobe is being elevated out of the wound. Just below the silver retractor a small, faintly tan, structure can be appreciated just deep to the upper aspect of the thyroid. This is a normal parathyroid gland. In …Read More »
Category: Parathyroid
Under the heading of “Parathyroid” we discuss a variety of surgically relevant topics about the parathyroid glands. Listed below are links to individual thyroid articles. You can go directly to the article that is important to you by clicking on the Title.
Primary Hyperparapthrydoidism (1˚HPT)
This is a parathyroid adenoma. It is a benign growth of one of the parathyroid glands and is the most common cause of 1°HPT. This gland weighs about 500 mg (about 10× normal size) and it is a typical parathyroid adenoma. One can appreciate how it is different from the normal parathyroid gland seen on …Read More »
Treatment of 1˚HPT
Once the diagnosis of 1°HPT is made surgery should be considered. Some elderly patients with mild disease, who are completely asymptomatic and are without evidence of heart, kidney or bone disease may be considered for observation (AAES Statement on the treatment of 1°HPT). Most patient are offered surgery as it is the only curative therapy. …Read More »
Secondary Hyperparathyroidism (2˚HPT)
Secondary hyperparathyroidism (2°HPT) is overactive parathyroid glands due to extra – parathyroid factors that stimulate otherwise normal parathyroid glands to be overactive. The two most common causes are kidney failure and vitamin D deficiency. 2°HPT is characterized by low normal or normal calcium levels and elevated PTH levels. Remember, 1°HPT is characterized by elevated calciumand …Read More »
Treatment of 2˚HPT
Once the decision for surgery has been made, a standard neck exploration to evaluate all 4 parathyroid glands is performed. Two approaches are used. One is a 3 and 1/2 gland resection. With this operation all parathyroid tissue except a portion of one gland is removed with the hope of reducing the PTH secretion to …Read More »
Tertiary Hyperparathyroidism (3˚HPT)
3°HPT develops in some cases of long standing 2°HPT when prolonged hypocalcemia causes the development of independently functioning parathyroid glands. Hypercalcemia develops and again the PTH levels are significantly elevated. This situation occurs most commonly in patients with chronic renal failure. The classic situation occurs when a patient with kidney failure (and 2°HPT) receives a …Read More »
Risk of Parathyroidectomy
The risk of parathyroid surgery is minimal. The risk of a serious complication is significantly less than 1%. Like other surgery, there are risks with anesthesia, bleeding and infection. These are quite small. As with thyroid surgery there is a risk of voice injury. This is rare. The superior parathyroid glands may be very close …Read More »
Post-Op Care After Parathyroid Surgery
Patients recover very quickly after parathyroidectomy, After surgery for 1°HPT most patients go home the same day. However those that have 3 and 1/2 gland resections (subtotal parathyroidectomy) are usually observed overnight because of the risk of hypocalcemia. There is very little pain. All wounds are closed with skin glue and the patient may shower …Read More »