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Endocrine surgery · London and UK

Focused parathyroidectomy, by a high-volume endocrine surgeon.

A short, day-case removal of a single overactive parathyroid gland through a 2 to 3 cm anterior neck incision, guided by concordant preoperative imaging and confirmed by intraoperative PTH monitoring in theatre.

A stethoscope on a clinical desk

Indicative pricing

What a private focused parathyroidectomy costs in the UK.

Indicative ranges across UK units in London and the wider UK.

In short

£8,500 to £14,000, home same day or one night.

Procedure Indicative range
Endocrine surgical consultation and localisation review £350–£650
Ultrasound neck (parathyroid protocol) £450–£750
MIBI SPECT-CT parathyroid scintigraphy £950–£1,600
4D-CT parathyroid (for MIBI-negative) £850–£1,400
Focused parathyroidectomy (MIP) with IOPTH £8,500–£14,000
Bilateral neck exploration (if focused not suitable) £11,000–£17,000

Prices vary by unit, by the named surgeon, by whether IOPTH is included, and by any combined thyroid surgery. Combined total thyroidectomy is quoted separately.

The problem

The right surgeon, the right localisation, the right operation.

A focused parathyroidectomy done on discordant imaging, without IOPTH, by a low-volume surgeon, is a recipe for a missed second adenoma and a re-do neck. We stop that happening.

  • Is focused MIP even the right operation?

    Discordant imaging, negative localisation, multi-gland syndromes or lithium use should go for bilateral neck exploration, not a blind focused attempt.

  • Worried about voice and calcium?

    Recurrent laryngeal nerve injury, hypocalcaemia and hungry-bone syndrome are the real risks. Quoted honestly, with nerve monitoring standard.

  • Want it done in a specialist unit?

    A named BAETS-registered endocrine surgeon, on-site rapid PTH assay, frozen section and clear escalation to bilateral exploration when needed.

When it helps

When a focused approach is the right step - and when it is not.

The patients we see most, plus the imaging and biochemistry patterns that mean focused MIP is abandoned in favour of bilateral neck exploration.

  • Symptomatic primary hyperparathyroidism

    Nephrolithiasis, osteoporosis, hypercalcaemic crisis, neuromuscular fibromyalgia-like symptoms or cognitive fog with a raised PTH and calcium.

  • Asymptomatic, but Bilezikian 2022 criteria met

    Age under 50, calcium more than 0.25 mmol/L above upper limit, GFR under 60, T-score at or below -2.5 at spine, hip or wrist, or a vertebral fracture.

  • Single adenoma on concordant imaging

    Ultrasound and MIBI SPECT-CT both pointing to the same gland is the ideal setup for a focused approach with IOPTH.

  • MIBI-negative but 4D-CT positive

    Around 10 to 20% of adenomas are MIBI-negative. 4D-CT or 18F-choline PET-CT often finds them and still allows a focused operation.

  • Recurrent or persistent hyperparathyroidism

    A re-do neck with prior scarring needs the most experienced hands, careful re-imaging, and a lower threshold for bilateral exploration.

  • Discordant or negative localisation

    When ultrasound and MIBI disagree, or both are negative, a focused approach is unsafe. Bilateral neck exploration is the honest recommendation.

  • Suspected multi-gland disease

    Familial hyperparathyroidism, MEN1, MEN2A or lithium-related disease. Multi-gland disease is not a focused-MIP indication.

  • Red flag: hypercalcaemic crisis

    Calcium above 3.5 mmol/L with dehydration, confusion or arrhythmia is an emergency. Rehydration and inpatient work-up first, not an outpatient booking.

Procedure options

Focused MIP sits alongside bilateral exploration and re-do surgery.

What each option on the table actually involves and which fits which case. See bilateral neck exploration for a fuller explanation of the BNE approach.

  • Focused (minimally invasive) parathyroidectomy

    A 2 to 3 cm lateral or midline incision over the localised gland, focused dissection, excision and IOPTH confirmation. The workhorse for concordant single-gland disease.

  • Intraoperative PTH monitoring (IOPTH)

    Baseline PTH at induction, then samples at 5 and 10 minutes after excision. A fall of over 50% from baseline (Miami criterion) confirms biochemical cure.

  • Bilateral neck exploration (BNE)

    The historical standard, still the right operation for discordant imaging, negative localisation, multi-gland disease or when IOPTH does not drop as expected.

  • Frozen section confirmation

    The excised specimen is sent to pathology during the operation to confirm parathyroid tissue rather than a lymph node, thyroid nodule or thymic fat.

  • Combined parathyroid + thyroid surgery

    When a coincident thyroid nodule or goitre needs addressing at the same sitting, the incision and approach are planned together. Costed as a combined case.

  • Re-do parathyroid surgery

    For persistent or recurrent disease after prior surgery. Requires meticulous re-imaging, sometimes with 18F-choline PET-CT, and a very experienced surgeon.

  • Second-opinion review

    A specialist review of your biochemistry, imaging and prior operative notes. Sometimes the answer is more work-up or observation rather than surgery.

Safety and recovery

What to expect afterwards - honestly.

Focused parathyroidectomy is a well-established operation with a cure rate of over 95% in the right hands. The things worth planning are your anaesthetic, calcium in the first month, your voice and your scar.

  • General anaesthesia, day-case or one night

    A short GA with a short-acting muscle relaxant. Most patients go home the same day; some stay one night for calcium monitoring, particularly with prior severe hypercalcaemia.

  • Transient hypocalcaemia

    A tingling in fingers and around the mouth in the first 24 to 72 hours is common (5 to 15%). Short-course oral calcium and calcitriol settle it quickly.

  • Hungry-bone syndrome

    After long-standing severe disease, bones rapidly re-mineralise and pull calcium out of the blood. Managed with higher-dose calcium and calcitriol for a few weeks.

  • Recurrent laryngeal nerve injury

    Temporary hoarseness in 1 to 3%; permanent injury in under 1% in high-volume hands with nerve monitoring. Discussed and consented before surgery.

  • Persistent hyperparathyroidism

    Calcium and PTH still raised after surgery, usually from a missed second adenoma or ectopic gland. Uncommon (2 to 5%) with concordant imaging and IOPTH.

  • Recurrent hyperparathyroidism

    Disease returning more than 6 months after a biochemical cure. Rare with true single-adenoma disease; more common in familial or multi-gland syndromes.

  • Scar and cosmesis

    A small horizontal anterior neck scar, usually 2 to 3 cm, sitting in a natural skin crease. Fades over 6 to 12 months. Silicone tape can be used from week two.

  • Return to normal activity

    Desk work at 3 to 5 days. Driving once off strong analgesia. Full exercise at 2 weeks. Avoid heavy lifting for 10 days to protect the closure.

  • Red flags after discharge

    Sudden neck swelling, difficulty breathing, severe tingling with muscle cramps, spasm at the wrist or a voice that will not come back after 48 hours. Call the unit or go to A&E.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever surgeon operated, the note you go home with keeps to the same shape.

A UK endocrine surgeon reviewing a parathyroidectomy operation note

A quiet reminder

Endocrine surgery language is precise and can read coldly - ask your care team to explain anything that is unclear.

Ask your care team to explain anything that is unclear.

  1. 01 Header

    Diagnosis, imaging and side of disease

    Confirmation of primary hyperparathyroidism, the localising studies used (US, MIBI SPECT-CT, 4D-CT) and which side and level the adenoma was expected.

  2. 02 Technique

    Focused approach and IOPTH values

    Incision size and side, dissection route, baseline PTH, PTH at 5 and 10 minutes post-excision, and whether the Miami criterion (over 50% drop) was met.

  3. 03 Findings

    Gland weight, frozen section, complications

    Weight of the excised gland, frozen-section confirmation of parathyroid tissue, any bleeding, and the status of the recurrent laryngeal nerve.

  4. 04 Impression

    Cure status and calcium plan

    Read this first: whether biochemical cure was achieved, your discharge calcium and calcitriol regimen, and when your first follow-up bloods are due.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for parathyroidectomy varies by insurer and by indication - usually funded when the Bilezikian criteria are met.

Frequently asked

Everything we get asked about focused parathyroidectomy.

Quick answers on imaging, IOPTH, complications, cost and when bilateral exploration is the safer option.

  • What is a focused parathyroidectomy?

    A focused (or minimally invasive) parathyroidectomy is a short operation to remove a single overactive parathyroid gland through a small 2 to 3 cm incision at the front of the neck. It is used when preoperative ultrasound and MIBI SPECT-CT both point to the same single gland. Intraoperative PTH monitoring confirms cure before you leave theatre.

  • Why do I need two imaging studies before surgery?

    Concordant localisation on two independent modalities (usually ultrasound and MIBI SPECT-CT) is the safest basis for a focused approach. If the two studies disagree, or if both are negative, the chance of missing a second gland is too high and bilateral neck exploration is the honest recommendation. 4D-CT or 18F-choline PET-CT can rescue focused surgery when MIBI is negative.

  • How much does a private focused parathyroidectomy cost in the UK?

    A focused parathyroidectomy with intraoperative PTH monitoring is typically £8,500 to £14,000 all-in at UK units, covering surgeon, anaesthetist, theatre, IOPTH assay and one overnight stay if needed. Bilateral neck exploration and combined thyroid surgery are priced separately.

  • What is the Miami criterion for IOPTH?

    The Miami criterion is the operative rule that a fall in parathyroid hormone of more than 50% from the highest pre-excision baseline, measured 10 minutes after removing the suspected adenoma, confirms biochemical cure. If PTH does not drop by 50%, the surgeon converts to a bilateral exploration to find another abnormal gland.

  • What are the risks of the operation?

    In high-volume hands, cure rates for concordant single-gland disease are over 95%. Transient hypocalcaemia occurs in 5 to 15% and settles with short-course calcium. Permanent recurrent laryngeal nerve injury is under 1%. Persistent hyperparathyroidism (missed gland) is 2 to 5%. Every risk is discussed and consented before surgery.

  • When is a focused approach not right for me?

    If ultrasound and MIBI disagree, if both are negative and 4D-CT or 18F-choline PET-CT do not localise, if there is likely multi-gland disease (MEN1, MEN2A, familial, lithium-related), or if you have had prior neck surgery with distorted anatomy, a formal bilateral neck exploration by a high-volume endocrine surgeon is the safer operation.

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