Parathyroidectomy

Illustration of the parathyroid glands that are situated behind the thyroid gland.

Do I need parathyroid surgery?

The only cure for primary hyperparathyroidism is the surgical removal of the overactive parathyroid gland(s). However, a proportion of asymptomatic patients may be monitored without needing surgery. Dr Bell will be able to discuss with you whether parathyroid surgery is the right choice for you.

How is a parathyroidectomy performed?

Parathyroid surgery can be performed in 2 ways, either a minimally invasive parathyroidectomy (MIP) or via a 4-gland/bilateral neck exploration. The decision which surgery is appropriate depends on whether there is one overactive gland or more and whether the abnormal gland can be localised. Dr Bell will explain what procedure is most suitable for you and the risks involved.

Minimally Invasive Parathyroidectomy (MIP)

This technique involves a small (2-3cm) incision in the neck, focused on the abnormal parathyroid gland. Only patients in whom the abnormal gland is easily identifiable on pre-operative imaging are suitable for this procedure.

4-Gland or Bilateral Neck Exploration

This technique is reserved for patients in whom scans fail to show the location of the abnormal gland, or there may be more than one abnormal gland present. In this procedure, all 4 glands will be looked at (through a slightly larger incision in the neck) and the abnormal gland(s) removed.

What are the risks of parathyroid surgery?

No surgery is without potential risk or side effects. Dr Bell is a specialised thyroid and parathyroid surgeon, who has received additional training to perform these operations safely. The main risks of parathyroid surgery relate to accidental damage to the surrounding structures. These include:

  • Damage to the nerve to the vocal cords (recurrent laryngeal nerve), causing voice changes and a hoarse voice

    • Dr Bell routinely uses a nerve integrity monitor (NIM™) during all parathyroid surgery to help identify and protect these nerves

  • Failure to find the abnormal gland and cure the hyperparathyroidism

  • Temporary drop in calcium levels to below-normal levels due to temporary underactive remaining calcium glands (after removal of the overactive gland), needing short-term calcium replacement

  • Permanent drop in calcium levels to below normal levels due to accidental damage to the normal calcium glands, needing long-term calcium replacement

  • Bleeding or haematoma (blood clot), potentially requiring a washout in theatre

  • Wound infection/fluid collection under the wound