Parathyroid surgery

Primary hyperparathyroidism is one of the most common hormone disorders. Around 95% of patients are cured by parathyroid surgery.

Endocrine Surgery
Patient information
5 min read

The parathyroid glands

There are four small parathyroid glands, two on each side of the neck, behind the much larger thyroid gland. Each normally measures about 5mm and weighs only 30–50mg.

They release parathyroid hormone (PTH), which keeps the level of calcium in the blood normal. Optimal calcium levels are vital for the nervous system and muscles, and for normal blood clotting. When calcium falls, PTH is released and acts on the bones, kidneys and gut to raise it; when calcium returns to normal, PTH release is reduced.

Primary hyperparathyroidism

Overactivity of the parathyroid glands is called primary hyperparathyroidism (pHPT). It becomes more common with age and is more common in older women.

What causes it?

Parathyroid adenoma – the most common cause: one gland enlarges, often to 20 times its normal size, and constantly releases high levels of PTH. Occasionally more than one adenoma is present.
Parathyroid hyperplasia – several glands enlarge and together release large amounts of PTH.
Parathyroid cancer – rare, occurring in less than 1% of cases.

What are the effects?

A raised blood calcium, which at high levels causes thirst and passing large amounts of urine.
Thinning of the bones (osteoporosis) and an increased risk of fractures.
Kidney stones, due to high calcium in the urine.
Higher rates of high blood pressure and stomach ulcers.
Tiredness, low mood and lack of energy, which frequently improve once the condition is cured.

Diagnosis and investigation

Most patients are diagnosed following routine blood tests. pHPT is also often found in people investigated for kidney stones or osteoporosis.

A bone density scan assesses any effect on the skeleton and the future risk of fractures.
A 24-hour urine collection may measure the amount of calcium excreted.
An ultrasound of the neck looks for enlarged parathyroid glands.
A nuclear medicine (sestamibi) scan identifies any overactive gland.

When is treatment needed?

Mild cases, with only a marginally raised calcium and no effect on the skeleton, may be managed with clinic follow-up and regular blood tests, usually under an endocrinologist.

Surgery is recommended for patients with a high calcium level, kidney stones, osteoporosis, or symptoms such as lethargy and low mood.

Parathyroid surgery

The operation to remove abnormal parathyroid glands is called a parathyroidectomy. The type of operation recommended depends on the results of the ultrasound and sestamibi scans.

Minimal incision parathyroidectomy

When the scans accurately identify a single abnormal gland, it can be removed through a small incision on the side of the neck. This is a very low-risk, simple procedure suitable for around 70% of patients. Mr Crinnion performs almost all parathyroid operations via this targeted approach.

Parathyroid exploration

If the scans are negative, a collar incision across the lower neck allows the surgeon to carefully look for and remove any abnormal glands. This is not a major procedure and the wound heals well with minimal scarring.

Results of surgery

About 95% of patients with primary hyperparathyroidism are cured with parathyroid surgery. Occasionally an operation is unsuccessful, and the reasons for this will be explained. Serious complications are extremely rare in the hands of an experienced thyroid and parathyroid surgeon.

Questions about your procedure?

Please contact Mr Crinnion’s secretary, Maxine Levene.

Tel: 0787 028 0264
Email: enquiries@jamescrinnion.co.uk

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Have a question about your operation?

Mr Crinnion’s office is happy to help before and after your procedure.