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Parathyroid Surgery

Parathyroid Anatomy

Most people have four parathyroid glands located in the neck, in the region of the thyroid gland. Normal parathyroid glands are tiny, about the size of the inside of a sunflower seed. Abnormal parathyroid glands are enlarged, about the size of a grape. These glands produce parathyroid hormone (PTH) which is responsible for controlling calcium metabolism. PTH regulates the deposition of calcium in the bones and excretion of calcium in the urine.

Diseases of the Parathyroid

Usually patients are referred to us with over-active parathyroid tissue, a condition known as hyperparathyroidism. In approximately 90% of patients one of the four parathyroid glands is overactive. Some patients have more than one abnormal gland. Hyperparathyroidism leads to elevated PTH which causes absorption of calcium from bone thereby weakening the bones, a condition known as osteoporosis or osteopenia. This causes an elevation of the blood calcium level which in turn results in elevated levels of calcium in the urine and can result in kidney stones and, over time, kidney damage. Patients with elevated blood calcium levels can suffer from depression, fatigue and muscle symptoms.


Patients are usually referred to us with elevated blood calcium levels as well as an elevated PTH level. Once the diagnosis has been established we ask patients to undergo a radiological examination which utilizes Sestamibi radioactive marker in conjunction with special CT imaging to locate the abnormal parathyroid tissue.


Once the diagnosis of hyperparathyroidism has been established, most patients are referred for definitive surgical therapy.

The Operation

In approximately 80% of patients with hyperparathyroidism the offending gland can be seen and localized on preoperative sestamibi imaging.

Patients who have a negative sestamibi scan still have the same disease, hyperparathyroidism, but their affected glands do not take up the marker and are not visible on preoperative sestamibi imaging. Frequently we can identify the offending gland using surgeon directed sonography.

In those patients with negative scans or multi-gland disease, our surgeons may also utilize an intra-operative parathyroid hormone blood test (IOPTH) to check levels of the parathyroid hormone before and after removing the abnormal gland. It many cases this information can help confirm that all the abnormal parathyroid tissue has been located and removed.


Depending upon the time required during operative treatment, you may be asked to spend the night in the hospital to be discharged the following morning.


Inherent in all parathyroid surgery are remote risks (1%) including hoarseness related to the proximity of voice box nerves to the parathyroid tissue. Low calcium levels may occur for a few days and are treated with oral calcium supplements for the first week. Persistent low calcium that requires treatment is rare (1%). Complications common to all surgeries such as infection or postoperative bleeding are rare (1%). Despite our best efforts, in approximately 1% of patients we are unable to locate the diseased gland and the patient has persistent hyperparathyroidism.