Parathyroid surgery | Specialists and information

The four parathyroid glands (parathyroid glands), which are about the size of a grain of rice, are located laterally behind the thyroid gland (thyroid gland). These play a very important role in bone metabolism and regulate the body's calcium-phosphate balance with the help of the parathyroid hormone they produce. A functional disorder of the parathyroid glands is known as hyperparathyroidism. In this case, too much parathyroid hormone (parathyroid hormone) is produced, which leads to various bone symptoms, among other things.

Brief overview:

  • Use of parathyroid surgery: People who suffer from hyperparathyroidism, i.e. an overactive parathyroid gland, often also suffer from osteoporosis. Parathyroid surgery can provide relief in certain circumstances.
  • Forms of hyperparathyroidism: A distinction is made between primary and secondary hyperparathyroidism. They differ in the cause of the disease.
  • Surgery: Depending on the diagnosis, only the causative adenoma, one or more parathyroid glands or even the entire thyroid gland is removed.
  • Procedure: The procedure is usually minimally invasive. An attempt is made to preserve part of the tissue so that it can continue to regulate calcium levels in the best possible way.
  • Prognosis: If the disease is detected early enough, the prognosis with parathyroid surgery is very favorable, with a 95-99% chance of success.
  • Centers: In order to keep the risk of complications low, treatment at a specialized center for thyroid and parathyroid surgery and at endocrine surgery centers is recommended.

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Article overview

Surgery to the parathyroid glands - Further information

What is the clinical picture of hyperparathyroidism?

Normally, the parathyroid glands measure the calcium content in the blood day and night. If this drops sharply, the parathyroid hormone released by the glands causes more calcium to be released from the bone stores.

In hyperparathyroidism, however, the parathyroid glands become overactive, so that even if the calcium level in the blood remains constant, too much parathyroid hormone continues to be released. In addition to calcium from the bones, phosphate is also increasingly released. The blood concentrations of calcium and phosphate then rise sharply.

The bones increasingly lose stability with the released minerals. As a result, bone fractures occur much more easily. Doctors also refer to this "bone softening" as osteoporosis. The excess calcium and phosphate is eventually eliminated from the blood in the form of stones. Bladder and kidney stones form in the urinary bladder or often in the kidneys.

Die Schilddrüse und Nebenschilddrüsen
The thyroid and parathyroid glands © Henrie | AdobeStock

Primary and secondary hyperparathyroidism

There are essentially two main forms of hyperparathyroidism. In primary hyperparathyroidism, there are individual cell growths within the glands, which are referred to as benign growths or adenomas. However, the adenomas permanently produce too much parathyroid hormone. As a rule, one or two parathyroid glands are affected at the same time.

In secondary hyperparathyroidism, the cause of the disease lies outside the parathyroid glands. This can be kidney disease or poorer calcium absorption in the body.

The resulting permanent calcium deficiency in the blood usually causes all four parathyroid glands to enlarge. The enlarged glands also produce more parathyroid hormone, which depletes the bone reserves of calcium.

Treatment of hyperparathyroidism - parathyroid surgery

In primary hyperparathyroidism, the causative adenoma is usually surgically removed. As only one or two glands are usually affected, the remaining parathyroid glands take over control of the calcium balance in the body. After parathyroid surgery, patients must continue to be monitored regularly in order to continuously observe the residual function of the parathyroid glands.

The removal of the parathyroid glands is also known as a parathyroidectomy. Depending on whether all four or only individual parathyroid glands are surgically removed, a distinction is made between total parathyroidectomy and subtotal parathyroidectomy. A special case is thyroidectomy, i.e. the partial or complete removal of the thyroid gland, e.g. as a result of a thyroid tumor.

Parathyroid surgery can be performed conventionally or, as a rule, minimally invasively, depending primarily on whether a thyroid disease is also present at the same time.

If all four parathyroid glands are affected, an attempt is made during parathyroid surgery to preserve part of the tissue of one gland, with continuous monitoring after the operation to check whether the function of the remaining gland tissue is sufficient to stabilize the calcium level in the blood using parathyroid hormone.

The parathyroid tissue is usually reimplanted in the area of the sternocleidomastoid muscle or the brachioradialis muscle. If surgery is required again, this allows quick access to the parathyroid tissue without having to reopen the structures of the neck or the area of the vocal cords.

Parathyroidectomy is the only treatment option aimed at curing primary hyperparathyroidism. The chances of success are 95-99% and are therefore very good.

However, there are also risks of complications due to the proximity of the surgical site, e.g. to the vocal cords. The complication rate is around 1-3%. However, the complication rate is significantly reduced if the parathyroid surgery is performed in a specialized thyroid center or in a center for endocrine surgery.

Disease with a favorable prognosis

If the disease is detected early and treated appropriately, the prognosis is very good overall. This applies both to surgical treatment (parathyroid surgery, parathyroidectomy) and to close follow-up monitoring of calcium levels in affected patients.

Who performs parathyroid surgery?

Parathyroid surgery is performed at specialized centers for thyroid and parathyroid surgery and in endocrine surgery centers. The German Society for General and Visceral Surgery carries out certifications for such competence, reference and excellence centers so that patients can recognize where sufficient specialist knowledge is available to have parathyroid surgery performed safely.

Currently, 36 centers throughout Germany hold the certificate.

References

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