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Surgical Management Of Primary Hyperparathyroidism - All You Must Know!

Written and reviewed by
Dr. Ashwini Reddy 92% (36 ratings)
MCh endocrine surgery
Endocrine Surgeon, Hyderabad  •  4 years experience
Surgical Management Of Primary Hyperparathyroidism - All You Must Know!

Primary hyperparathyroidism results from dysfunctional parathyroid glands. These are 4 pea-sized glands near the thyroid gland. The disease is called “Primary” since the disorder starts from the parathyroid glands themselves, and are not a consequence of some other health problem.

In such a condition, one or more of these glands become overactive. This results in these glands making too much parathyroid hormone. This causes a spike in calcium levels in the blood resulting in multiple health problems like kidney stones, thinning of bone, constipation, loss of appetite, confusion, etc. However, the good news is that primary hyperparathyroidism can be detected early through routine blood tests.

Treatment of Primary Hyperparathyroidism
Surgery is often recommended by doctors to treat primary hyperparathyroidism. It has been seen that surgical intervention can drastically bring down the symptoms in almost 95% of cases. While performing the surgery, the surgeon would remove only the enlarged and affected glands. If all the parathyroid glands are enlarged, the surgeon may have to remove three glands completely and the fourth one partly.

In most cases, the surgery is done through a small incision in the neck with the help of local anaesthetics. However, it is up to the doctor to decide if you are a candidate for surgery or not.

A candidate for surgery with primary hyperparathyroidism may fulfil the following criteria: 

● Blood calcium of more than 1 mg/dL
● Low bone density
● History of kidney stones or evidence of risk of kidney stone
● A bone fracture arising out of relatively little force
● Age is less than 50

However, the surgery can be performed even if the patient does not meet guidelines as long as there are no medical problems that surgery can aggravate or that prohibit surgery. Even in patients who don’t want to undergo surgery, doctors can prescribe surgery depending upon the condition. However, if the patient is a candidate for surgery due to medical complications, the doctor has to treat symptomatically to control the level of calcium in the blood and to improve bone density.

Surgery
There are two main types of surgical intervention:

● Minimally Invasive Parathyroidectomy: Surgeons resort to this process when there is a possibility of only one parathyroid gland being overactive. The surgeon conducts a tumour-imaging test, makes a small incision in the neck and removes the gland.

● Bilateral Neck Exploration: In this type of surgery, a larger incision is made in the neck to explore and have a look at all the parathyroid glands. This helps them to remove only the overactive ones.

Conclusion
Surgical removal of overactive parathyroid gland/s is the best way to cure this disease. This can be done as an outpatient, and one can return home on the same day. However, it is always advisable to consult an experienced surgeon to carry out this procedure.

In case you have a concern or query you can always consult an expert & get answers to your questions!
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