Parathyroid Surgery

Most commonly, removal of one or more of these glands is required because of they have grown abnormally and have started to produce an excessive amount of parathyroid hormone. This condition is called Primary Hyperparathyroidism and can lead to excessive levels of calcium in your blood. This in turn can lead to a range of health problems (see below).

Less often, surgery may be required in people with end stage kidney disease, because the glands become enlarged in this condition and produce too much PTH.

Extremely rarely, parathyroid glands are removed because they become cancerous.

Very commonly, you will not notice any symptoms. The problem is often picked up only on a blood test.

When symptoms of hypercalcaemia (too much calcium in your blood) do occur, they can be very vague and include:

• Stomach upset, nausea, vomiting, or constipation
• Kidney stones and resulting pain or other problems from them
• Fatigue, lethargy, confusion, and sometimes depression
• Excessive thirst and frequent urination
• Bone pain and muscle weakness
• Rarely, palpitations and fainting if excessive calcium interferes with your heart function

Even if you have no symptoms, leaving an abnormally functioning parathyroid gland untreated can lead to long-term problems. These can include:

• Weakening of your bones (osteoporosis) and increased likelihood of fractures
• Development of kidney stones and kidney disease
• Neuropsychiatric problems

Because the parathyroid glands are so tiny, sometimes the culprit parathyroid gland can be difficult to locate. For this reason, quite extensive pre-operative testing and scans are required to try to best pinpoint which side the problem is.

At the operation, the surgeon will usually start exploring the side of the neck where the problem gland is most likely to be. As in thyroid surgery, a specialised nerve stimulator is used to identify and protect the important nerve in your neck (recurrent laryngeal nerve).

If an obviously abnormal gland is found, this is removed. Very often, this gland is sent to a pathologist in a lab immediately to confirm that it is parathyroid tissue. Once this is confirmed, the operation is concluded and the wound closed.

In cases where a culprit gland cannot be located on one side, the surgeon will move to the other side to attempt to locate the problem gland there. In very rare situations, the problem gland may not be found on either side. In these rare situations, the operation is concluded and more extensive testing is required.

Most patients stay one night in hospital and go home the next day.

You will get a blood test immediately after surgery and one more the next morning to check your calcium and PTH levels. In situations where blood calcium levels are too low after surgery, a few more days may be required to stabilise these levels before discharge.

Most of the time, long term medications after parathyroid surgery are not required.

In the early post-operative period, you may need some calcium supplementation in the short-term.

These are similar to thyroid surgery, and are very rare, but they can include:

1. Bleeding, which may require going back to remove blood clots
2. Wound infection
3. Damage to nearby structures and nerves, in particular the recurrent laryngeal nerve
4. Inability to locate the culprit parathyroid gland
5. Removal of some or all of the thyroid gland if necessary
6. Long term need for calcium supplementation

Read more about parathyroid surgery here. https://www.healthdirect.gov.au/surgery/parathyroidectomy

Our surgeons currently operate at:

• Mulgrave Private Hospital, Mulgrave
• St John of God Hospital, Berwick
• Peninsula Private Hospital, Frankston
• Knox Private Hospital, Wantirna

Our surgeon Mr Andrew Chong performs our thyroid and parathyroid surgeries. Read more about him here.