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Parathyroid Surgery (Parathyroidectomy)

Surgical removal of one or more hyperfunctioning parathyroid glands for primary, secondary, or tertiary hyperparathyroidism using minimally invasive focused parathyroidectomy or bilateral neck exploration with intraoperative PTH monitoring.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our KBB (Kulak Burun Boğaz) department. Book Appointment →

What is Parathyroid Surgery (Parathyroidectomy)?

Parathyroidectomy is the surgical removal of one or more abnormal parathyroid glands to treat hyperparathyroidism. Primary hyperparathyroidism (single adenoma in 80-85%, double adenomas in 5%, hyperplasia in 10-15%) is the most common indication, characterized by elevated calcium and PTH levels with associated symptoms including kidney stones, bone disease, neuromuscular complaints, and cardiovascular effects.

Modern surgical approaches include minimally invasive parathyroidectomy (MIP) for solitary localized adenomas using preoperative sestamibi scan and ultrasound, four-gland exploration when localization is unsuccessful or hyperplasia suspected, video-assisted parathyroidectomy through small incisions, and robotic transaxillary or transoral parathyroidectomy avoiding visible neck scars. Subtotal (3.5 gland) parathyroidectomy is standard for hyperplasia and secondary/tertiary hyperparathyroidism.

Intraoperative PTH monitoring (rapid PTH assay) confirms successful surgery when levels drop more than 50% from baseline within 10 minutes of adenoma removal. Cure rates exceed 95% with experienced surgeons. Postoperative considerations include calcium supplementation for hungry bone syndrome, vitamin D management, monitoring for recurrent laryngeal nerve injury, and long-term surveillance for recurrent hyperparathyroidism.

Symptoms

Recurrent kidney stones (calcium oxalate or calcium phosphate)
Osteoporosis with fragility fractures despite treatment
Bone pain, joint pain, and muscle weakness
Fatigue, depression, cognitive impairment ('moans, groans, stones')
Polyuria, polydipsia from hypercalciuria-induced renal tubular dysfunction
Constipation, peptic ulcer disease, pancreatitis from hypercalcemia
Cardiovascular: hypertension, left ventricular hypertrophy, vascular calcification

Risk Factors

Female sex (3:1 female:male predominance for primary hyperparathyroidism)
Age >50 years
Family history of MEN1 (multiple endocrine neoplasia type 1)
Family history of MEN2A (medullary thyroid cancer + pheochromocytoma + parathyroid)
Chronic kidney disease (secondary hyperparathyroidism)
Lithium therapy (lithium-induced hyperparathyroidism)
Prior neck radiation (rare cause of parathyroid carcinoma)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent hypercalcemia on routine blood work
  • Recurrent kidney stones with elevated calcium
  • Osteoporosis or fragility fractures with elevated PTH
  • Symptoms of hypercalcemia (fatigue, cognitive issues, bone pain)
  • Family history of MEN syndromes with calcium abnormalities
  • End-stage renal disease with secondary hyperparathyroidism not controlled medically
  • Newly diagnosed primary hyperparathyroidism for surgical evaluation

Treatment Methods

01
Confirmation of biochemical hyperparathyroidism: calcium, PTH, 24-hour urinary calcium, vitamin D, phosphorus, creatinine, alkaline phosphatase
02
Localization studies: technetium-99m sestamibi scan with SPECT/CT, high-resolution neck ultrasound, 4D CT for ectopic glands
03
Bone density assessment (DEXA), kidney imaging for stones, baseline laryngoscopy for vocal cord assessment
04
Minimally invasive focused parathyroidectomy for localized solitary adenoma with intraoperative PTH monitoring
05
Bilateral neck exploration for non-localized adenomas, suspected hyperplasia, or secondary/tertiary hyperparathyroidism
06
Subtotal (3.5 gland) parathyroidectomy with autotransplantation in forearm for diffuse hyperplasia
07
Postoperative calcium and vitamin D supplementation, monitoring for hungry bone syndrome, recurrent laryngeal nerve assessment, long-term biochemical surveillance

Which Department to Visit?

You can visit our KBB (Kulak Burun Boğaz) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.