Parathyroid Surgery | Specialists and Information

Normally, the parathyroid glands regulate the calcium level in the blood around the clock. If this level drops significantly, the parathyroid hormone released by the glands causes more calcium to be released from the bone stores.

In hyperparathyroidism, the parathyroid glands become overactive. Even when blood calcium levels remain constant, the parathyroid glands continue to release excessive amounts of parathyroid hormone.

In addition to calcium from the bones, phosphate is also increasingly released. Blood levels of calcium and phosphate then rise very sharply.

As these minerals are released, the bones gradually lose stability. As a result, fractures occur much more easily.

Doctors refer to this “softening of the bones” as osteoporosis. The excess calcium and phosphate are eventually eliminated from the blood in the form of stones. This leads to the formation of bladder or kidney stones, often in the bladder or kidneys.

Medical professionals essentially distinguish between two main forms of hyperparathyroidism:

1. In primary hyperparathyroidism, there are isolated cell growths within the glands, also known as benign growths or adenomas. However, these adenomas continuously produce too much parathyroid hormone. Typically, one or two parathyroid glands are affected at the same time.
2. In secondary hyperparathyroidism, the cause of the disease lies outside the parathyroid glands. This can be a kidney disease or reduced calcium absorption in the body. The resulting chronic calcium deficiency in the blood typically causes all four parathyroid glands to enlarge. The enlarged glands also produce more parathyroid hormone, which depletes the body’s calcium reserves in the bones.

In cases of primary hyperparathyroidism, doctors usually surgically remove the causative adenoma.

Since usually only one or two glands are affected, the remaining parathyroid glands take over the regulation of calcium balance.

After parathyroid surgery, doctors must continue to monitor the patient regularly to keep track of the remaining parathyroid glands’ function.

The removal of the parathyroid glands is also referred to by physicians as a parathyroidectomy.

Depending on whether doctors surgically remove all four or only some of the parathyroid glands, they distinguish between:

• total parathyroidectomy and
• subtotal parathyroidectomy

A special case is thyroidectomy, which is 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, using minimally invasive techniques. This depends primarily on whether a thyroid disorder is also present.

If all four parathyroid glands are affected, doctors attempt to preserve part of the tissue from one gland during parathyroid surgery.

After the surgery, they continuously monitor whether the function of the remaining glandular tissue is sufficient to stabilize blood calcium levels.

The parathyroid tissue is reimplanted in the area of the sternocleidomastoid muscle (Musculus sternocleidomastoideus) or the brachioradialis muscle (Musculus brachioradialis).

This allows for rapid access to the parathyroid tissue should another operation be necessary. To do this, doctors do not need to reopen the structures of the neck or the area around the vocal cords.

Parathyroidectomy is the only curative treatment option for primary hyperparathyroidism. The success rate is 95–99%, which is very high.

However, due to the proximity of the surgical site to structures such as the vocal cords, there are also risks of complications. The complication rate is approximately 1–3%.

The complication rate is significantly lower when the surgery is performed at a specialized thyroid center. The same applies to a center for endocrine surgery.

If doctors diagnose and treat the condition in a timely manner, the overall prognosis is very good. This applies to surgical treatment (parathyroid surgery, parathyroidectomy), provided that close follow-up monitoring of calcium levels is performed.

Parathyroid surgery is performed at specialized centers for thyroid and parathyroid surgery as well as at endocrine surgery centers. 

The German Society for General and Visceral Surgery certifies such centers of excellence. This allows patients to quickly identify where there is sufficient specialized expertise to safely undergo parathyroid surgery.

Currently, 36 centers across Germany hold this certification.