Ways to remove the parathyroid gland: indications and possible postoperative consequences. Operations on the parathyroid glands Operation to remove parathyroid adenoma consequences

The parathyroid glands are glands of the endocrine system, located in pairs along the posterior surface of the thyroid gland at its upper and lower points. In frequent cases, dysfunction of the parathyroid glands leads to the development of hypoparathyroidism or, in other words, parathyroid insufficiency.

Excess production of parathyroid hormone leads to hyperparathyroidism, in which the only treatment option is surgery. If such a need arises, and doctors recommend only the removal of the parathyroid gland, the consequences can be very different.

In hyperparathyroidism, the production of parathyroid hormone increases, which leads to an increase in calcium levels. To get rid of the pathology, the only treatment used today is parathyroidectomy, in other words, the removal of the parathyroid glands.

Indications for the operation

Before the operation, the patient is carefully examined by an endocrinologist, and if a pathology is suspected, he prescribes appropriate tests. The disease has several stages, all of which require surgical intervention.

Hyperparathyroidism happens:

• primary;
• secondary;
• tertiary;
• carcinoma (malignant tumor).

The first three cases are characterized by solitary benign neoplasms. Multiple tumors usually occur in 2-4% of cases. They mainly appear in secondary and tertiary hyperparathyroidism.

The situation is aggravated by chronic renal failure, against which the development of these two stages of the disease occurs. But the last case is the most serious, requiring immediate surgery. Medical forecasts, unfortunately, are not always comforting.

In the photo, our readers can see where the parathyroid glands are located:

Attention. Such operations are characterized by increased complexity, therefore they are carried out in highly specialized medical institutions. Such clinics are equipped with only modern equipment, the price of which is quite high. Preoperative high-quality diagnostics will allow for surgical intervention with the least damage to healthy tissues.

Diagnostics

The operation to remove the parathyroid glands is the final stage of the examination, which is carried out in several stages by an endocrinologist.

These steps are listed in the table below:

Since both stages are very important for the treatment of hyperparathyroidism, the instructions adopted by the international community of endocrinologists must be strictly followed during their implementation.

Operation types

Modern medicine is moving forward and today there are several types of surgical interventions that are performed on the parathyroid glands.

This:

• standard operation;
• surgical intervention with minimal access;
• minimally invasive operation;
• video-assisted intervention procedure.

The most commonly used is a minimally invasive operation, in which an incision with a scalpel is made no more than 2 centimeters. In this procedure, the latest endovideo technology is used, which makes it possible to accurately determine the affected areas and remove the tumor as accurately as possible without affecting healthy tissues.

Before the operation, a biooptical control is performed, which will indicate the nature and localization of pathological changes. Parathyroid hormone and calcium levels are also checked using an intraoperative test. After a minimally invasive operation, the traces of intervention are minimal and the rehabilitation period is shorter than after a standard surgical procedure.

The video-assisted intervention procedure uses a new generation of special surgical instruments and optical systems that help to achieve amazing accuracy in the removal of affected tissues. This procedure also differs from others in the absence of pain and a good cosmetic result.

The most important step in surgical intervention is the preoperative diagnosis. The accuracy of the diagnostic results allows you to achieve maximum results and clearly plan the course of the operation.

Methods for removing parathyroid glands

Removal of the parathyroid glands is carried out by one of two methods:

• subtotal parathyroidectomy;
• total parathyroidectomy.

Table number 1. Subtotal and total parathyroidectomy:

Important. If all parathyroid glands are damaged in a patient, drastic measures are not taken, as this can cause nipoparathyroidism. Only three glands and part of the fourth are removed, which makes it possible to ensure the normal production of parathyroid hormone in the future.

Care after parathyroidectomy

Patient care after parathyroidectomy is carried out in a hospital in the clinic, in duration it is 2-3 days. In case of possible complications, the doctor can increase the length of stay under medical supervision.

Table number 2. Rules of behavior of the patient in the postoperative period:

If a danger is identified in the postoperative period, you should immediately seek the advice of a specialist. Some patients experience complications after surgery, which requires constant medical monitoring.

Complications

In the postoperative period, there may be some complications that no one can rule out, although such interventions rarely involve such a risk. Surgical interventions using modern equipment reduce the likelihood of complications.

It can be:

• bleeding in the suture area;
• hoarseness and loss of voice;
• low level of calcium in the blood;
• infection;
• difficulty in breathing and talking;
• reaction to anesthesia;
• scarring;
• damage to the nerve endings (may cause paralysis of the vocal cords).

Factors that have a high risk of developing complications in a patient:

• smoking;
• intake of alcoholic beverages;
• disorders of the cardiovascular system.

Important. It is necessary to take into account one feature that after the operation the patient needs to take a calcium preparation to prevent the development of hypocalcemia. Instructions for use of the drug and the term is prescribed by the doctor. You also need to adhere to the right lifestyle, proper nutrition and drinking regimen.

Hypoparathyroidism

Separately, it is worth mentioning hypoparathyroidism, which accompanies the removal of the parathyroid glands. This complication can be caused not only by surgery.

Hypoparathyroidism is:

1. Postoperative (surgery on the parathyroid glands, as well as the thyroid gland with the removal or damage to one or several glandulae parathyroideae).
2. Post-traumatic (caused by hemorrhages, infectious agents, radiation exposure and other factors).
3. idiopathic.
4. Autoimmune.
5. Congenital (due to the initial underdevelopment or absence of the parathyroid glands).

Symptoms of pathology

The leading clinical manifestation of hypoparathyroidism is tetanic (convulsive) syndrome, in which neuromuscular excitability increases against the background of a lack of parathyroid hormone release. It is manifested by strong convulsions of various muscles, which accompany severe pain.

Tetany is preceded by a number of specific symptoms:

1. Numbness of the skin and tingling.
2. Muscle stiffness.
3. Feeling of "crawling" on the skin of the upper lip, fingers of the upper and lower extremities.
4. Coldness of hands and feet.

Harbingers are replaced by convulsive contractions of symmetrically located muscle groups (starts with the arms, then goes to the legs). In some cases, the muscles of the face, trunk and internal organs are included in the process (depending on which of them will be affected and the corresponding symptoms will develop).

The table below shows the muscle groups and their characteristic manifestations:

Seizures in this disease are very painful, and their frequency of occurrence and duration depend on the form of the disease:

1. With mild - develop from one to two times during the week, while the attack lasts up to several minutes.
2. In severe cases, they can repeat several times a day and last for more than one hour.

Seizures can develop spontaneously, but some external factors can also provoke them:

1. Pain.
2. mechanical impact.
3. Overheating or burning.
4. Electric discharge.
5. Loud noise.
6. Hyperventilation of the lungs.

Seizures in some cases are accompanied by the following symptoms:

1. Paleness of the skin.
2. Fluctuations in blood pressure.
3. Tachycardia.
4. Vomit.
5. Diarrhea.
6. Loss of consciousness (severe cases).

Vegetative symptoms in hypoparathyroidism are very extensive:

1. Increased perspiration.
2. Vertigo.
3. Brief loss of consciousness in the form of fainting.
4. Feelings of "congestion" of the ears, ringing.
5. Hearing loss.
6. Disorders of concentration of vision.
7. Decreased visual acuity.
8. Arrhythmias.
9. Pain behind the sternum.
10. Disturbances in the sensitivity of various receptors (temperature - the patient is thrown into the cold, then into the heat, taste - the patient perceives the sour taste worse, but feels bitter and sweet much more acutely, auditory - the person becomes more sensitive to the level of noise, loud and harsh sounds).

If the peripheral blood of people suffering from hypoparathyroidism for a long time remains low in Ca2 + ions, then mental status changes may begin, consisting in the following manifestations:

1. Falling intelligence.
2. Memory deterioration.
3. Neuroses.
4. Various types of emotional lability (attacks of melancholy and depression).
5. Sleep disorders.

Also, chronic hypoparathyroidism causes a number of tissue trophism disorders:

1. The skin is dry, it begins to peel off and changes its pigmentation, later vesicles with serous contents, eczema, and fungal infections join.
2. Nails are brittle.
3. Hair turns gray very early, their growth is disturbed, partial or complete baldness gradually appears.
4. Tooth tissues are damaged, both in children (violation of their formation, in some areas of the enamel, the phenomenon of its hypoplasia), and in adults (enamel is damaged and carious phenomena develop).
5. Growth retardation in children.
6. The development of cataracts, in which the lens becomes cloudy, which causes a drop in visual acuity up to complete blindness.
7. Calcification of brain tissues.

If hypoparathyroidism proceeds latently, then convulsive manifestations can occur against the background of acute infectious diseases, intoxications, hypovitaminosis, and pregnancy. In order to prevent all these severe disorders that develop when the parathyroid glands are lost after removal of the thyroid gland or surgical interventions on them, replacement therapy should be started in a timely manner and undergo it throughout the entire period prescribed by the doctor.

In the video in this article, experts will tell our readers what modern technologies and equipment are used to perform operations to remove the parathyroid glands.

The parathyroid glands are glands of the endocrine system, located in pairs along the posterior surface of the thyroid gland at its upper and lower points. In frequent cases, dysfunction of the parathyroid glands leads to the development of hypoparathyroidism or, in other words, parathyroid insufficiency.

Excess production of parathyroid hormone leads to hyperparathyroidism, in which the only treatment option is surgery. If such a need arises, and doctors recommend only the removal of the parathyroid gland, the consequences can be very different.

In hyperparathyroidism, the production of parathyroid hormone increases, which leads to an increase in calcium levels. To get rid of the pathology, the only treatment used today is parathyroidectomy, in other words, the removal of the parathyroid glands.

Indications for the operation

Before the operation, the patient is carefully examined by an endocrinologist, and if a pathology is suspected, he prescribes appropriate tests. The disease has several stages, all of which require surgical intervention.

Hyperparathyroidism happens:

• primary;
• secondary;
• tertiary;
• carcinoma (malignant tumor).

The first three cases are characterized by solitary benign neoplasms. Multiple tumors usually occur in 2-4% of cases. They mainly appear in secondary and tertiary hyperparathyroidism.

The situation is aggravated by chronic renal failure, against which the development of these two stages of the disease occurs. But the last case is the most serious, requiring immediate surgery. Medical forecasts, unfortunately, are not always comforting.

In the photo, our readers can see where the parathyroid glands are located:

Attention. Such operations are characterized by increased complexity, therefore they are carried out in highly specialized medical institutions. Such clinics are equipped with only modern equipment, the price of which is quite high. Preoperative high-quality diagnostics will allow for surgical intervention with the least damage to healthy tissues.

Diagnostics

The operation to remove the parathyroid glands is the final stage of the examination, which is carried out in several stages by an endocrinologist.

These steps are listed in the table below:

Since both stages are very important for the treatment of hyperparathyroidism, the instructions adopted by the international community of endocrinologists must be strictly followed during their implementation.

Operation types

Modern medicine is moving forward and today there are several types of surgical interventions that are performed on the parathyroid glands.

This:

• standard operation;
• surgical intervention with minimal access;
• minimally invasive operation;
• video-assisted intervention procedure.

The most commonly used is a minimally invasive operation, in which an incision with a scalpel is made no more than 2 centimeters. In this procedure, the latest endovideo technology is used, which makes it possible to accurately determine the affected areas and remove the tumor as accurately as possible without affecting healthy tissues.

Before the operation, a biooptical control is performed, which will indicate the nature and localization of pathological changes. Parathyroid hormone and calcium levels are also checked using an intraoperative test. After a minimally invasive operation, the traces of intervention are minimal and the rehabilitation period is shorter than after a standard surgical procedure.

The video-assisted intervention procedure uses a new generation of special surgical instruments and optical systems that help to achieve amazing accuracy in the removal of affected tissues. This procedure also differs from others in the absence of pain and a good cosmetic result.

The most important step in surgical intervention is the preoperative diagnosis. The accuracy of the diagnostic results allows you to achieve maximum results and clearly plan the course of the operation.

Methods for removing parathyroid glands

Removal of the parathyroid glands is carried out by one of two methods:

• subtotal parathyroidectomy;
• total parathyroidectomy.

Table number 1. Subtotal and total parathyroidectomy:

Important. If all parathyroid glands are damaged in a patient, drastic measures are not taken, as this can cause nipoparathyroidism. Only three glands and part of the fourth are removed, which makes it possible to ensure the normal production of parathyroid hormone in the future.

Care after parathyroidectomy

Patient care after parathyroidectomy is carried out in a hospital in the clinic, in duration it is 2-3 days. In case of possible complications, the doctor can increase the length of stay under medical supervision.

Table number 2. Rules of behavior of the patient in the postoperative period:

If a danger is identified in the postoperative period, you should immediately seek the advice of a specialist. Some patients experience complications after surgery, which requires constant medical monitoring.

Complications

In the postoperative period, there may be some complications that no one can rule out, although such interventions rarely involve such a risk. Surgical interventions using modern equipment reduce the likelihood of complications.

It can be:

• bleeding in the suture area;
• hoarseness and loss of voice;
• low level of calcium in the blood;
• infection;
• difficulty in breathing and talking;
• reaction to anesthesia;
• scarring;
• damage to the nerve endings (may cause paralysis of the vocal cords).

Factors that have a high risk of developing complications in a patient:

• smoking;
• intake of alcoholic beverages;
• disorders of the cardiovascular system.

Important. It is necessary to take into account one feature that after the operation the patient needs to take a calcium preparation to prevent the development of hypocalcemia. Instructions for use of the drug and the term is prescribed by the doctor. You also need to adhere to the right lifestyle, proper nutrition and drinking regimen.

Hypoparathyroidism

Separately, it is worth mentioning hypoparathyroidism, which accompanies the removal of the parathyroid glands. This complication can be caused not only by surgery.

Hypoparathyroidism is:

1. Postoperative (surgery on the parathyroid glands, as well as the thyroid gland with the removal or damage to one or several glandulae parathyroideae).
2. Post-traumatic (caused by hemorrhages, infectious agents, radiation exposure and other factors).
3. idiopathic.
4. Autoimmune.
5. Congenital (due to the initial underdevelopment or absence of the parathyroid glands).

Symptoms of pathology

The leading clinical manifestation of hypoparathyroidism is tetanic (convulsive) syndrome, in which neuromuscular excitability increases against the background of a lack of parathyroid hormone release. It is manifested by strong convulsions of various muscles, which accompany severe pain.

Tetany is preceded by a number of specific symptoms:

1. Numbness of the skin and tingling.
2. Muscle stiffness.
3. Feeling of "crawling" on the skin of the upper lip, fingers of the upper and lower extremities.
4. Coldness of hands and feet.

Harbingers are replaced by convulsive contractions of symmetrically located muscle groups (starts with the arms, then goes to the legs). In some cases, the muscles of the face, trunk and internal organs are included in the process (depending on which of them will be affected and the corresponding symptoms will develop).

The table below shows the muscle groups and their characteristic manifestations:

Seizures in this disease are very painful, and their frequency of occurrence and duration depend on the form of the disease:

1. With mild - develop from one to two times during the week, while the attack lasts up to several minutes.
2. In severe cases, they can repeat several times a day and last for more than one hour.

Seizures can develop spontaneously, but some external factors can also provoke them:

1. Pain.
2. mechanical impact.
3. Overheating or burning.
4. Electric discharge.
5. Loud noise.
6. Hyperventilation of the lungs.

Seizures in some cases are accompanied by the following symptoms:

1. Paleness of the skin.
2. Fluctuations in blood pressure.
3. Tachycardia.
4. Vomit.
5. Diarrhea.
6. Loss of consciousness (severe cases).

Vegetative symptoms in hypoparathyroidism are very extensive:

1. Increased perspiration.
2. Vertigo.
3. Brief loss of consciousness in the form of fainting.
4. Feelings of "congestion" of the ears, ringing.
5. Hearing loss.
6. Disorders of concentration of vision.
7. Decreased visual acuity.
8. Arrhythmias.
9. Pain behind the sternum.
10. Disturbances in the sensitivity of various receptors (temperature - the patient is thrown into the cold, then into the heat, taste - the patient perceives the sour taste worse, but feels bitter and sweet much more acutely, auditory - the person becomes more sensitive to the level of noise, loud and harsh sounds).

If the peripheral blood of people suffering from hypoparathyroidism for a long time remains low in Ca2 + ions, then mental status changes may begin, consisting in the following manifestations:

1. Falling intelligence.
2. Memory deterioration.
3. Neuroses.
4. Various types of emotional lability (attacks of melancholy and depression).
5. Sleep disorders.

Also, chronic hypoparathyroidism causes a number of tissue trophism disorders:

1. The skin is dry, it begins to peel off and changes its pigmentation, later vesicles with serous contents, eczema, and fungal infections join.
2. Nails are brittle.
3. Hair turns gray very early, their growth is disturbed, partial or complete baldness gradually appears.
4. Tooth tissues are damaged, both in children (violation of their formation, in some areas of the enamel, the phenomenon of its hypoplasia), and in adults (enamel is damaged and carious phenomena develop).
5. Growth retardation in children.
6. The development of cataracts, in which the lens becomes cloudy, which causes a drop in visual acuity up to complete blindness.
7. Calcification of brain tissues.

If hypoparathyroidism proceeds latently, then convulsive manifestations can occur against the background of acute infectious diseases, intoxications, hypovitaminosis, and pregnancy. In order to prevent all these severe disorders that develop when the parathyroid glands are lost after removal of the thyroid gland or surgical interventions on them, replacement therapy should be started in a timely manner and undergo it throughout the entire period prescribed by the doctor.

In the video in this article, experts will tell our readers what modern technologies and equipment are used to perform operations to remove the parathyroid glands.

Surgical interventions on the parathyroid glands, like operations on the thyroid gland, are operations of increased complexity. It is very important that the operation on the parathyroid glands is performed by an endocrinologist surgeon in a specialized surgical department.

Indications for surgery

Operations on the parathyroid gland can be recommended to the patient if an adenoma, a benign neoplasm of the parathyroid gland, is detected.

The parathyroid glands are paired glandular structures on the posterior surface of the thyroid gland. These organs are necessary for a person to produce parathyroid hormone, an important component of calcium-phosphorus metabolism. With adenoma, the hormonal balance is disturbed, the human body gradually begins to break down, and hyperparathyroidism develops.

Parathyroid adenoma usually overtakes people aged 40-60 years, while women suffer from the disease 2-3 times more often than men.

Removal of the gland is prescribed for diseases such as:

• hyperparathyroidism of varying degrees - the operation is prescribed for primary, secondary hyperparathyroidism, the latter develops against the background of renal failure;
• cancer (carcinoma) of the parathyroid gland.

If a parathyroid adenoma or carcinoma is detected, the patient is recommended surgery. It is important to note that parathyroid cancer is rare in less than 1% of cases in primary hyperparathyroidism. In primary hyperparathyroidism, a single tumor is most often formed, only in 2-5% of cases there are multiple neoplasms, which should also be removed.

Causes of parathyroid adenoma

According to endocrinologists, parathyroid adenoma develops due to the following reasons:

• Mitotic control mutation and changes in genes involved in protein coding, calcium transport in the tissues of the parathyroid glands. Simply put, the cell loses its ability to secrete hormones, clone cells begin to divide at lightning speed, and a tumor appears.
• Lack of calcium in the body can provoke random cell division and the occurrence of parathyroid adenoma.
• Parathyroid injury and tissues adjacent to it. Radiation can also lead to a parathyroid adenoma.

In 1-2 cases out of 100 adenoma degenerates into a malignant tumor.

Symptoms of parathyroid adenoma

Unfortunately, a small adenoma rarely manifests itself, so only an endocrinologist can make a clear diagnosis based on the results of the examination. However, the following dominant manifestations of the disease can be identified:

• increased sweating;
• release of moisture droplets on the skin even in a calm state;
• drowsiness;
• increased heart rate;
• fast fatiguability;
• enlargement of the thyroid gland (goiter).

As we have already said, in most cases, due to parathyroid adenoma, the patient develops hyperparathyroidism. This disease is accompanied by the following symptoms:

• general weakness;
• constipation;
• nausea;
• memory impairment;
• pain in the joints;
• tendency to depression;
• psychical deviations;
• convulsions.

For the bone form of hyperparathyroidism, disorders of the musculoskeletal system are typical, which are characterized by:

• osteoporosis;
• loosening of teeth;
• sudden fractures of tubular bones.

A parathyroid adenoma can also lead to a gastrointestinal form of hyperparathyroidism, in which:

• exacerbated ulcers of the stomach and duodenum;
• develops pancreatitis with severe abdominal pain.

Diagnosis before surgery

Removal of a parathyroid adenoma or a malignant neoplasm is prescribed only after a thorough diagnosis of the diseases and the patient's condition. During the tests, the endocrinologist needs to identify:

The presence of diseases of the parathyroid glands. The patient is prescribed blood and urine tests.

Location of tumors. If hyperparathyroidism has been identified, the location of the parathyroid adenoma should be determined. For this, patients are prescribed ultrasound, scintigraphy (scanning with technetrile) of the parathyroid glands, as well as computed tomography of the organ.

An endocrinologist conducts a thorough examination of the patient in order to identify the presence of parathyroid diseases and the location of tumors of parathyroid adenoma. For this, the following are carried out:

• physical examination of the patient;
• Ultrasound of the thyroid and parathyroid glands;
• Daily urine analysis reveals the amount of excreted calcium;
• General and biochemical blood test;
• Ultrasound of the abdominal organs in order to exclude diseases of the gastrointestinal tract;
• Binuclide scintigraphy - intravenous administration of radioisotopes, performing scintigrams to differentiate adenoma;
• X-ray of the bones of the skull, upper and lower extremities;
• Fibrogastroduodenoscopy - to detect erosions and ulcers;
• ECG and echocardiogram;
• TAB of the parathyroid gland for biopsy examination.

Preparation for surgery on the parathyroid glands (parathyroid)

When the patient received a consultation from an endocrinologist surgeon and surgical treatment is recommended, it is necessary to determine the date of the operation. It is important to note that there is no fundamental importance at what time of the year to perform the operation. There is no special preparation for surgery on the parathyroid glands, the main requirement is the absence of acute and exacerbation of chronic diseases in the body. Upon admission to the clinic, the patient undergoes tests (clinical blood test, biochemical, urinalysis, blood type, “coagulogram”, “immunogram”, chest x-ray and additional tests if necessary). After receiving the results of the tests, the patient is examined by a therapist and an anesthesiologist (a doctor who performs anesthesia). It is obligatory to have a conversation with the operating surgeon, who explains and answers all questions of interest to the patient. An obligatory step before the operation is to perform an ultrasound of the neck.

During the period of preoperative preparation, the patient must undergo a course of conservative treatment of parathyroid adenoma, which includes:

• Dieting. During the treatment of parathyroid adenoma, the patient should consume foods low in calcium.
• Droppers with diphosphonates, saline sodium chloride.
• Intravenous infusions are prescribed if the patient has a hypercalcemic crisis. Assign infusion of glucose solution, corticosteroids, sodium bicarbonate.

Operation on the parathyroid glands (parathyroid)

Like thyroid surgery, parathyroid surgery is performed under general anesthesia (the patient is in drug sleep and does not feel pain).

The anesthesiologist monitors the patient's condition during the operation. As a rule, the procedure lasts from 60 minutes to 3-4 hours. Surgical treatment of parathyroid adenoma is carried out using:

• Subtotal resection - removal of the main part of the gland;
• Total parathyroidectomy
• Selective parathyroidectomy

Patients often ask about the possibility of performing the operation under local anesthesia. It is important to understand that at present the level and quality of anesthesia are at a high level and from the point of view of safety for the patient, the operation "under anesthesia" is the best choice. The duration of the operation is from 40 minutes to several hours.

Complications after surgical treatment of parathyroid adenoma are extremely rare, because if you choose the right doctor and clinic, the operation will be successful. In about 1 in 500 cases, unpleasant side effects are observed, such as:

• Infection;
• bleeding;
• Scarring;
• Hoarseness, difficulty speaking.

If you find the above side effects, you should definitely contact your endocrinologist.

life forecast

The parathyroid glands are made up of four distinct parts that are small and round. They are attached to the thyroid gland in the neck. They are part of the endocrine system. Your endocrine system produces and regulates hormones that affect your growth, development, and mood.

The parathyroid glands regulate the amount of calcium in the blood. When calcium levels are low, they release parathyroid hormone (PTH), which takes calcium from your bones.

Parathyroid gland removal refers to a type of surgery performed to remove these glands. It is also known as a parathyroidectomy. This operation may be used if your body produces too much calcium. This condition is known as hypercalcemia.

Purpose Why do I need a parathyroid gland removal?

Hypercalcemia occurs when the level of calcium in the blood is abnormally high. The most common cause of hypercalcemia is an overproduction of PTH in one or more parathyroid glands. This is a form of hyperparathyroidism called primary hyperthyroidism. Primary hyperthyroidism is twice as common in women as in men. Most people diagnosed with primary hyperthyroidism are over 40 years of age. The median age of diagnosis is 65 years.

You may also need to have your parathyroid gland removed if you have:

• tumors called adenomas, which are most often benign and rarely turn into cancerous tumors
• on or near glands
• parathyroid hyperplasia, which is a condition in which all four parathyroid glands are enlarged
• a history of thyroidectomy, which involves removing the thyroid gland

Blood levels of calcium may rise even if only one gland is affected. Only around the parathyroid gland is involved in approximately 80% of cases.

Symptoms may be vague in the early stages of hypercalcemia. As the condition progresses, you may have:

• fatigue
• depression
• muscle pain
• loss of appetite
• nausea
• vomit
• excessive thirst
• frequent urination
• abdominal pain
• constipation
• muscle weakness
• confusion
• stones in the kidneys
• bone fractures

People without symptoms may only need monitoring. Mild cases may be managed medically. However, only surgery that removes the affected glands will provide a cure.

The most serious consequences of hypercalcemia:

• kidney failure
• hypertension
• arrhythmia
• coronary artery disease
• enlarged heart

This may be due to calcium buildup in the arteries and heart valves.

Types of SurgeonsTypes of Parathyroid Removal Surgery

There are various approaches to finding and removing affected parathyroid glands.

In the traditional method, your surgeon visually examines all four glands to see which ones are diseased and which should be removed. This is called a bilateral neck examination. Your surgeon makes an incision in the middle of the lower part of the neck. Sometimes the surgeon removes both glands on one side.

If you only have one diseased gland, you are likely to have a minimally invasive parathyroidectomy. Examples of this type of operation are:

Radiopedagogical parathyroidectomy

In a radiographic parathyroidectomy, your surgeon uses radioactive material that will only absorb the diseased glands. A special probe can find the radiation source. Your surgeon will need to make a small incision to remove the diseased gland.

Video-assisted parathyroidectomy

In video adaptive parathyroidectomy, your surgeon uses a small camera. They make two cuts in the neck so that the camera and instruments can fit.

Endoscopic parathyroidectomy

In an endoscopic parathyroidectomy, your surgeon makes two or three small incisions in the neck and near the breastbone. This minimizes visible scarring. This technique is similar to video surgery.

These minimally invasive methods allow you to speed up recovery. However, if not all glands found and removed are found, high calcium levels will continue and a second operation may be required.

People with parathyroid hyperplasia usually have three and a half parathyroid glands. The surgeon will leave the remaining tissue to control calcium levels. However, tissue will be implanted in an accessible location, like the forearm, in case it needs to be removed later.

Preparation Preparation for surgery

You need to stop taking medications that interfere with your blood's ability to clot about a week before surgery. These include:

• aspirin
• clopidogrel
• ibuprofen (Advil)
• naproxen (Aleve)
• warfarin

Your anesthetist will review your medical history with you and determine which form of anesthesia to use. You also need to fast before surgery.

Risks Risks of surgery

The risks of this operation primarily include the risks associated with any other type of operation. First, general anesthesia can cause breathing problems and allergic reactions to the medications used. As with other surgeries, bleeding and infection are possible.

Risks from this particular surgery include injury to the thyroid and vocal cords. In rare cases, you may have trouble breathing. They usually go away a few weeks or months after surgery.

Blood calcium levels usually drop after this operation. This is called hypocalcemia. You may experience numbness or tingling in your fingertips, toes, or lips. This is easily treated with calcium supplements and this condition responds quickly to supplements. Usually this is not permanent.

You may also want to see an experienced surgeon to reduce your risk factors. Surgeons who perform at least 50 parathyroidectomies per year have the lowest rates of surgery complications. However, it is important to remember that no operation can be guaranteed to be completely risk-free.

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Outlook after surgery

You can return home on the same day of surgery or spend the night in the hospital. There is usually pain or discomfort after surgery, such as a sore throat. Most people can return to their normal activities after a few days.

As a precautionary measure, blood calcium levels will be monitored for at least six to twelve months after surgery. You can take supplements for up to a year after surgery to rebuild bones that have been deprived of calcium.

Editor's Choice

healthcare professional

The parathyroid (parathyroid) glands are an organ located on the posterior surface of the thyroid gland. Most people have 2 pairs. Normally, the number of glands can be from 2 to 8. The main function of the organ is to produce hormones that affect calcium-phosphorus metabolism. When tumor formations occur in the glands, this process is disrupted.

Adenoma of the parathyroid glands (parathyroidadenoma) is a benign hormonally active formation, which is surrounded by a clearly defined capsule. ICD code 10 - D34. The danger of the disease is that in the process of tumor growth, compression of nearby tissues occurs, which leads to their deformation and impaired blood supply. The prognosis of parathyroid adenoma depends on various factors: the size of the formation, its hormonal activity. The sooner the pathology is detected and treated, the higher the likelihood of a favorable outcome.

general information

Parathyroid adenoma can be single or multiple. It is characterized by the ability to synthesize parathyroid hormone, which leads to a critical increase in its level in the blood. According to statistics, 90% of primary cases are associated with the presence of an adenoma.

The size of the formation is usually small, but parathyroid adenomas are sometimes diagnosed, weighing about 100 g and the size of a chicken egg. Most often, adenomas are localized in the lower parathyroid glands. They are surrounded by a smooth capsule, have a soft, elastic texture. In the section, the adenoma has a red-brown tint, it contains foci of necrosis, small hemorrhages, small cystic cavities with fluid inside.

Depending on what types of cells form a tumor, there are several types of parathyroid adenomas:

• alveolar;
• oxyphilic;
• clear cell;
• main cell.

Causes

What is the direct cause of parathyroid adenoma is not fully understood. Predisposing factors for the development of pathology can be:

• gene mutations of cells in the parathyroid gland;
• neck injuries;
• cervical osteochondrosis;
• exposure to radiation;
• calcium deficiency in food.

Characteristic symptoms

The clinical picture of parathyroid adenoma is quite blurred, which significantly complicates its diagnosis.

The disease can be manifested by disorders of different systems:

• renal;
• cardiovascular;
• bone.

The main symptoms to watch out for are:

• strong sweating;
• drowsiness;
• constant fatigue;
• tachycardia;
• decrease in general tone;
• dizziness.

Parathyroid adenoma actively produces parathyroid hormone. As a result, hyperparathyroidism occurs, which is characterized by:

• weakness;
• frequent vomiting;
• constipation;
• loss of appetite;
• transient joint pain;
• convulsions;
• emotional breakdowns;
• depression;
• intellectual disability.

The skeletal system reacts to parathyroid adenoma with characteristic manifestations:

• osteoporosis;
• frequent fractures and cracks of bones;
• loosening of teeth.

From the gastrointestinal tract there are:

• severe bouts of vomiting;
• frequent exacerbations of peptic ulcer;
• steatorrhea;
• pancreatitis.

On a note! The cardiovascular system suffers from high calcification of the arteries, the heart valve, which leads to hypertension and can cause a heart attack. On the part of the kidneys, nephrocalcinosis, urolithiasis develops. All these changes are associated with hypercalcemia, which develops against the background of an increased level of parathyroid hormone.

If the calcium level exceeds 3.7 mmol / l, a hypercalcemic crisis may develop. It is accompanied by certain symptoms:

• pain in the epigastric part;
• continuous vomiting;
• oliguria;
• gastrointestinal bleeding;
• disturbance of consciousness.

Diagnostics

Since the symptoms of parathyroid adenoma are diverse and manifest from different organs and systems, a comprehensive examination is necessary, consultation of several narrow specialists in order to differentiate it from other pathologies.

Diagnosis of the disease includes the following studies:

• visual examination and history taking;
• blood test for calcium, phosphorus;
• subtraction scintigraphy;
• bone radiography;
• arteriography;
• fibrogastroduodenoscopy;

A comprehensive examination makes it possible to determine the genesis of the pathology of the parathyroid gland, differentiate it from other diseases and correctly prescribe treatment.

General rules and effective methods of treatment

You can get rid of adenoma only by surgery. Before the intervention, patients are prescribed preparatory conservative therapy.

To suppress hypercalcemia, apply:

• bisphosphonates;
• isotonic solution;
• Hypothiazide (thiazide diuretic);
• sodium phosphate;
• forced diuresis.

In severe cases, it may be necessary to administer a glucose solution, cardiac glycosides, corticosteroids. The doctor determines the dosage of drugs individually, based on the age of the patient, the severity of the condition, concomitant pathologies. Be sure to adhere to a diet that limits the use of foods rich in calcium.

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Access to the adenoma is carried out in several ways:

• open;
• decreased;
• endoscopic.

The operation is done under general anesthesia. The volume of intervention and duration may be different, depending on the characteristics of the spread of adenoma. In most cases, with single formations, surgeons perform organ-preserving operations. In the process of their implementation, an examination of all parathyroid glands and surrounding tissues for pathological changes is mandatory.

Forecast of life and recovery

If a parathyroid adenoma is detected and treated in a timely manner, then the prognosis is usually favorable. Rehabilitation after surgery does not last long. During this period, it is necessary to constantly monitor the concentration of calcium in the blood. Normally, it should stabilize within 2-3 days after the removal of the formation.

In advanced cases, the prognosis is less favorable. Prolonged hypercalcemia against the background of an elevated level of parathyroid hormone leads to irreversible consequences on the part of many systems. Calcium accumulates in the tissues of the organs, in the vessels, which causes corresponding changes and problems.

Parathyroid adenoma responds well to treatment. The main thing is to identify the pathology at an early stage of development, and eliminate it. Otherwise, progressive hyperparathyroidism against the background of adenoma leads to severe complications. Treatment will become increasingly difficult and the prognosis for recovery less favorable.