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Parathyroid Surgery
The parathyroid glands and hyperparathyroidism
The parathyroid glands are 4 pea-sized glands which are usually located
next to the thyroid gland in the neck (Figure
1). Occasionally, a parathyroid gland can be found in other locations
in the neck as well as in the upper chest. The parathyroid glands make
parathyroid hormone (PTH), which controls the levels of calcium in the
body. In patients with hyperparathyroidism, one or more parathyroid
glands become enlarged and make too much parathyroid hormone. This causes
the levels of calcium to rise in the blood. About 100,000 people in
the US develop hyperparathyroidism each year. Symptoms due to high calcium
can include fatigue, loss of appetite, muscle aches, joint pain, and
constipation. More severe symptoms include stomach ulcers, depression,
loss of bone density, bone pain/fractures, and kidney stones. The diagnosis
of hyperparathyroidism is made based on a high blood calcium and a high
blood PTH level.
A single enlarged parathyroid gland, or a parathyroid adenoma is the
cause of the hyperparathyroidism in the majority (80%) of patients (Figure
2). In about 10% of patients, two parathyroid glands are enlarged (abnormal)
(Figure 3). In 10% of patients, all 4 glands are enlarged (Figure 4).
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Figure 2
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Figure 3
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Figure 4
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Parathyroid
adenoma
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Enlargement of
2 parathyroid
glands
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Enlargement
of all 4 parathyroid
glands
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Parathyroid scan
In most patients, we can determine which parathyroid glands are abnormal
before surgery using a parathyroid scan. Almost all patients will undergo
a parathyroid scan prior to surgery. Some patients may have two scans.
During a parathyroid scan, the patient receives a small injection of a
radiolabelled compound which accumulates in the parathyroid glands. The
patient lies on his/her back and rests while the scanner looks for the
parathyroid glands (Figure 5). It is a painless, non-invasive procedure.
If the scan detects one enlarged parathyroid gland, then the patient is
a candidate for minimally invasive parathyroidectomy.
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Figure 5
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Parathyroid scanner
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Minimally Invasive Radioguided or "targeted" Parathyroidectomy
(MIP or MIRP)
On the day of surgery, the patient receives another injection of the radiolabelled
compound about 1 hour before surgery. At the time of surgery, the surgeon
will use a small probe to detect the exact location of the enlarged parathyroid
gland (Figure 6). The surgeon will then make a small 0.5 inch to 2 inch
incision directly over the parathyroid gland. The surgery can be performed
under local or general anesthesia. After removal of the enlarged parathyroid
gland, and while the patient is still under anesthesia, the surgeon will
perform a blood test checking the patient’s parathyroid hormone level
in the operating room. This blood test will allow the surgeon to confirm
that all enlarged parathyroid glands have been removed before the patient
leaves the operating room.
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Figure 6
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Parathyroid probe
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Most patients go home the same day of surgery but some choose to stay
overnight in the hospital and go home the next morning. Dr. Chen has
performed more than 900 MIRPs over the last few years.
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