Parathyroidectomy: surgery for an overactive parathyroid gland

The parathyroid glands are small glands in the neck that control the amount of calcium in your body. The NHS explains that hyperparathyroidism happens when the body produces too much parathyroid hormone (PTH), which can affect the amount of calcium in the blood and, in turn, the blood, bones and kidneys. Parathyroidectomy is the operation to remove the gland or glands that are overactive.

The NHS says that primary hyperparathyroidism is caused by a non-cancerous growth (adenoma) on the parathyroid glands, and that secondary hyperparathyroidism happens when low calcium or vitamin D levels, or high phosphate levels, drive the glands. Surgery is for the first group. The NHS says secondary hyperparathyroidism treatment may include medicines and supplements.

The NHS says treatment is usually needed for hyperparathyroidism, and that getting treatment can stop it getting worse and prevent complications. If it is not treated it can lead to osteoporosis, kidney stones and high blood pressure, which can raise the risk of heart disease and stroke.

Many people with hyperparathyroidism have no, or very mild, symptoms and are found by chance on blood or urine tests for something else. When there are symptoms the NHS lists tiredness, aches and pains, muscle weakness, feeling and being sick, loss of appetite, constipation, tummy pain, thirst, passing more urine and low mood. The BAETS statement says primary hyperparathyroidism is common in the UK and that a successful operation can make a big difference to people’s lives.

The NHS says hyperparathyroidism can be diagnosed by testing samples of blood and urine, and that further tests and scans may be recommended to check your general health and help plan treatment. These can include ultrasound scans, X-rays and bone density scans.

BAETS notes that surgery can be straightforward when a localised adenoma is found, or more difficult when scans are negative and the surgeon has to undertake a bilateral neck exploration without knowing exactly where the affected gland or glands are. It adds that there are adjuncts that may help decision-making during the operation in more difficult cases, though these are not available in every hospital.

The sources read for this guide do not give a step-by-step description of the operation. The NHS says surgery removes part or all of the glands, and BAETS describes two broad approaches: removal of a localised adenoma, and a bilateral neck exploration, in which the surgeon looks at the glands on both sides of the neck.

The BAETS leaflet mentions that after a neck exploration you should be able to eat and drink normally, though some patients feel as though there is a lump in the throat when they swallow, and that the scar may be red for a few months before fading. Ask your surgeon which approach is planned for you, whether it will be day-case surgery, and what anaesthetic is used.

The BAETS patient leaflet on consequences of parathyroid surgery says the operation is generally safe and the vast majority of patients have no complications, but there are risks that should be fully explained to you by your surgical team.

Your surgical team will check calcium levels after the operation. BAETS says to seek attention from your GP or surgical team if you feel tingling or spasms in your lips, fingers or toes, because this could indicate low calcium. Some units prescribe vitamin D before surgery to make sure you are replete.

If voice problems persist for more than three months, the leaflet says you will be referred for voice therapy and sometimes further surgery is needed. People whose work depends heavily on their voice should tell the surgeon beforehand. The sources read do not give a timetable for returning to work or normal activities, so ask your surgical team for written advice. If calcium levels remain high, BAETS says the surgeon will explain what happens next, which may involve repeating tests and scans.

On the NHS, people with hyperparathyroidism are referred to a specialist for treatment, and the NHS says treatment depends on the cause. BAETS notes that many patients with primary hyperparathyroidism remain on long waiting lists and that the association is trying to prioritise the condition nationally.

Some people choose private surgery to reduce the wait. BAETS keeps a “Find a Surgeon” tool listing surgeons who contribute data to the national audit database, which can help you check experience. Whichever route you use, ask how many parathyroid operations the surgeon performs, whether they take part in audit, and who will manage your calcium and bone health afterwards.