What is Parathyroidectomy? Purpose, Procedure & Recovery

Parathyroidectomy is a surgical procedure to remove one or more of your parathyroid glands. These four tiny glands, each about the size of a grain of rice, sit behind your thyroid gland in your neck and control calcium levels in your blood.

When these glands become overactive or develop tumors, they can cause serious health problems by producing too much parathyroid hormone. Your doctor might recommend this surgery to restore your body's natural calcium balance and prevent complications like kidney stones, bone loss, or heart problems.

What is parathyroidectomy?

Parathyroidectomy is the surgical removal of one or more parathyroid glands when they're not working properly. Your parathyroid glands are four small, oval-shaped glands located behind your thyroid in your neck.

These glands produce parathyroid hormone (PTH), which acts like a thermostat for calcium in your blood. When calcium levels drop, PTH tells your bones to release calcium and your kidneys to absorb more calcium from your urine.

Sometimes one or more of these glands become enlarged or develop benign tumors called adenomas. This causes them to produce too much PTH, leading to dangerously high calcium levels in your blood - a condition called hyperparathyroidism.

The surgery can involve removing just the problematic gland (if only one is affected) or multiple glands depending on your specific condition. Your surgeon will determine the best approach based on your test results and imaging studies.

Why is parathyroidectomy done?

Parathyroidectomy is performed to treat hyperparathyroidism, a condition where your parathyroid glands produce too much hormone. This excess hormone causes calcium levels in your blood to rise too high, which can damage multiple organs over time.

The most common reason for this surgery is a benign tumor called a parathyroid adenoma, which affects about 85% of people with hyperparathyroidism. These tumors aren't cancerous, but they make the affected gland work overtime, producing excessive amounts of parathyroid hormone.

Your doctor might recommend surgery if you're experiencing symptoms that affect your quality of life. High calcium levels can make you feel tired, confused, or depressed, and you might notice muscle weakness or frequent urination.

The surgery becomes more urgent if you develop serious complications. These can include kidney stones, bone loss leading to osteoporosis, heart rhythm problems, or kidney damage from persistently high calcium levels.

Less commonly, the surgery treats parathyroid cancer, which occurs in fewer than 1% of cases. Even rarer conditions like multiple endocrine neoplasia syndromes might also require this procedure to prevent future complications.

What is the procedure for parathyroidectomy?

Parathyroidectomy is typically performed under general anesthesia and takes about 1-2 hours. Your surgeon will make a small incision in the lower part of your neck, usually about 2-3 inches long.

During the surgery, your surgeon carefully separates the muscles and tissues to reach your parathyroid glands. They'll examine each gland to identify which ones are enlarged or abnormal, often using special techniques to preserve your voice box nerves.

If only one gland is affected, your surgeon will remove just that gland in a procedure called focused parathyroidectomy. This minimally invasive approach uses a smaller incision and often allows for faster recovery.

When multiple glands are involved, your surgeon might perform a more extensive procedure. They may remove 3½ glands, leaving a small portion of healthy tissue to maintain some parathyroid function, or transplant some healthy tissue to your forearm.

Throughout the surgery, your surgeon may test your parathyroid hormone levels in real-time. This helps confirm they've removed the correct glands and that your hormone levels are dropping appropriately.

Some surgeons use advanced techniques like intraoperative nerve monitoring to protect your vocal cords, or minimally invasive approaches using smaller incisions with the help of special imaging or surgical tools.

How to prepare for your parathyroidectomy?

Your preparation begins with a thorough medical evaluation to ensure you're ready for surgery. Your doctor will review your medications, especially any blood thinners, and may ask you to stop certain medications before the procedure.

You'll need to arrange for someone to drive you home after surgery, as you won't be able to drive while recovering from anesthesia. Plan to have a friend or family member stay with you for the first 24 hours after your procedure.

Your surgical team will give you specific instructions about eating and drinking before surgery. Typically, you'll need to avoid food and liquids for 8-12 hours before your procedure to prevent complications during anesthesia.

Prepare your home for recovery by setting up a comfortable resting area with extra pillows to keep your head elevated. Stock up on soft foods and have ice packs ready, as these can help reduce swelling after surgery.

If you smoke, try to quit or reduce smoking before surgery, as this can improve your healing process. Your doctor might also recommend certain supplements or medications to help manage your calcium levels before and after the procedure.

How to read your parathyroidectomy results?

Success after parathyroidectomy is primarily measured by your calcium and parathyroid hormone levels returning to normal ranges. Your doctor will check these levels within hours after surgery and continue monitoring them during your recovery.

Normal calcium levels typically range from 8.5 to 10.5 mg/dL, though your doctor will consider your individual baseline. You should see your calcium levels drop within 24 hours of surgery if the procedure was successful.

Your parathyroid hormone levels will also be tested regularly. Normal PTH levels range from about 15 to 65 pg/mL, and these should normalize within days to weeks after removing the overactive glands.

Sometimes your calcium levels might drop too low temporarily, a condition called hypocalcemia. This happens because your remaining parathyroid glands need time to adjust and start working properly again after being suppressed for so long.

Your doctor will track your symptoms as well as your lab results. Relief from symptoms like fatigue, muscle weakness, or mental fog can take several weeks to months as your body adjusts to normal calcium levels.

Long-term follow-up includes monitoring for bone health improvement, kidney function, and ensuring your remaining parathyroid glands continue working properly. Most people see gradual improvement in bone density and kidney function over the months following surgery.

How to manage your recovery after parathyroidectomy?

Your recovery focuses on managing calcium levels and allowing your neck to heal properly. Most people go home the same day or after an overnight hospital stay, depending on their calcium levels and overall health.

You'll likely need calcium and vitamin D supplements initially, as your remaining parathyroid glands adjust to their new workload. Your doctor will prescribe specific doses based on your blood test results and adjust them as needed.

Watch for signs of low calcium, which can include tingling around your mouth or in your fingers, muscle cramps, or feeling anxious. These symptoms usually improve as your calcium levels stabilize, but contact your doctor if they're severe or persistent.

Take care of your incision by keeping it clean and dry, and avoid heavy lifting or strenuous activities for about 2 weeks. Most people can return to desk work within a few days, but physical jobs may require a longer recovery period.

Your voice might sound different or feel weak initially due to swelling near your vocal cords. This typically improves within days to weeks, but let your doctor know if voice changes persist beyond a few weeks.

What are the best outcomes after parathyroidectomy?

The best outcome is achieving normal calcium and parathyroid hormone levels that remain stable long-term. Most people experience this success, with cure rates exceeding 95% when performed by experienced surgeons.

Excellent results also include relief from symptoms that brought you to surgery in the first place. Many people notice improved energy levels, better mood, clearer thinking, and reduced muscle weakness within weeks to months.

Long-term benefits include protection from serious complications like kidney stones, bone loss, and heart problems. Your kidney function often improves, and your bones may become stronger over time as calcium regulation normalizes.

The best outcomes occur when you maintain regular follow-up care and take prescribed supplements as directed. Your doctor will monitor your progress and adjust treatments to ensure your calcium levels remain in the healthy range.

Quality of life improvements are often dramatic, with many people describing feeling like themselves again after years of subtle symptoms they didn't realize were related to their parathyroid condition.

What are the risk factors for needing parathyroidectomy?

Age and gender play significant roles in your risk, with women over 50 being most commonly affected. Postmenopausal women have particularly higher rates of parathyroid problems, possibly due to hormonal changes that affect calcium metabolism.

Certain genetic conditions can increase your risk, including multiple endocrine neoplasia syndromes and familial hypocalciuric hypercalcemia. If you have family members with parathyroid problems, you may have an increased risk of developing them yourself.

Previous radiation exposure to your neck area, especially during childhood, can increase your risk of developing parathyroid tumors later in life. This includes radiation treatments for other cancers or even older medical procedures that used radiation.

Long-term kidney disease can affect your parathyroid glands, sometimes leading to secondary hyperparathyroidism that may require surgical treatment. Severe vitamin D deficiency over many years can also contribute to parathyroid problems.

Certain medications, particularly lithium used for mood disorders, can affect parathyroid function over time. Some people who take lithium long-term may develop parathyroid adenomas that require surgical removal.

What are the possible complications of parathyroidectomy?

The most common complication is temporary low calcium levels, which affects about 10-30% of people after surgery. This usually resolves within days to weeks as your remaining parathyroid glands begin working normally again.

Voice changes can occur if the surgery affects the nerves that control your vocal cords. Most voice changes are temporary and resolve within weeks, but permanent voice changes occur in less than 1% of cases when performed by experienced surgeons.

Bleeding or infection at the surgical site are rare but possible complications. Signs include unusual swelling, redness, warmth, or drainage from your incision, and these require immediate medical attention.

Permanent hypoparathyroidism is a rare but serious complication where too much parathyroid tissue is removed, leaving you unable to maintain normal calcium levels. This requires lifelong calcium and vitamin D supplementation.

Very rarely, people may experience persistent or recurrent hyperparathyroidism if abnormal tissue wasn't completely removed or if multiple glands were affected. This might require additional surgery or alternative treatments.

Extremely rare complications include damage to nearby structures like the esophagus or major blood vessels, but these occur in less than 1% of procedures when performed by skilled surgeons.

When should I see a doctor after parathyroidectomy?

Contact your doctor immediately if you experience severe symptoms of low calcium, including muscle spasms, severe cramping, or tingling that spreads beyond your mouth and fingertips. These symptoms can indicate dangerously low calcium levels.

Call your healthcare provider if you notice signs of infection around your incision, such as increased redness, warmth, swelling, or pus-like drainage. Fever above 101°F (38.3°C) after the first day also warrants immediate attention.

Seek medical care if you develop severe neck swelling or have difficulty breathing or swallowing. While rare, these symptoms could indicate bleeding or swelling that needs urgent treatment.

Schedule a follow-up appointment if your voice changes persist beyond 2-3 weeks or if you notice your voice becoming progressively weaker rather than improving. Most voice changes resolve on their own, but persistent problems may need evaluation.

Contact your doctor if you feel extremely fatigued, confused, or depressed several weeks after surgery, as these could indicate ongoing calcium imbalances that need adjustment in your medications.