Parathyroid Gland Conditions and Services

  • Parathyroid Gland Removal
  • Primary Hyperparathyroidism
  • Renal (secondary/tertiary) Hyperparathyroidism
  • Normocalcemic Hyperparathyroidism
  • Re-Operative Parathyroid Surgery for Recurrent or Persistent Hyperparathyroidism
  • Parathyroid Cancer

Types of Parathyroid Surgery

Focused Parathyroidectomy

In this surgery, the single diseased parathyroid gland is identified pre-operatively by using localization studies, such as the sestamibi scan or a parathyroid ultrasound. Intraoperative PTH monitoring is used to confirm there are no other diseased parathyroid glands.

Minimally Invasive Radioguided Parathyroidectomy

This is a type of focused parathyroidectomy that uses radioactive material to assist in localizing the diseased parathyroid gland. On the morning of surgery, a small intravenous injection of Technetium 99m sestamibi is given to the patient. The radioactivity concentrates in the diseased parathyroid gland. In the operating room, the surgeon uses a hand-held gamma probe to focus in on the identity of the diseased parathyroid gland for removal. Intraoperative PTH monitoring is used to confirm there are no other diseased parathyroid glands.

Bilateral Neck Exploration

Also known as an open parathyroidectomy, the bilateral neck exploration is the traditional surgical approach to hyperparathyroidism. In this surgery, usually the diseased parathyroid gland could not definitively be pre-operatively localized. Therefore, all four parathyroid glands must be located and assessed for disease. After the diseased parathyroid gland is removed, intraoperative PTH monitoring is used to confirm there are no other diseased parathyroid glands.

Four Gland Hyperplasia

It is rare to have all four parathyroid glands diseased. However, if that is the case, treatment options would include removing 3 ½ parathyroid glands with ½ parathyroid gland left intact or removing all four parathyroid glands and transplanting part of a parathyroid gland in the neck.

Surgery

Parathyroid surgery is typically done with general anesthesia. You will have a breathing tube in place during the surgery, which is removed after surgery prior to you waking up. A bilateral neck exploration parathyroidectomy can take approximately 90 minutes. The focused parathyroidectomy and minimally invasive radio-guided parathyroidectomy usually completed in less time.

The University of Maryland Medical Center surgeons typically use incisions measuring approximately two inches in length hidden in a natural skin crease. Once the redness fades away, the incision will not be noticeable to most people.

Intraoperative PTH testing is used to check the blood parathyroid hormone level (PTH) during surgery. PTH is produced by the parathyroid glands and a diseased parathyroid gland will release abnormally high levels. Prior to surgery, the PTH level will be abnormally high. After the diseased parathyroid gland is removed, the PTH level will return to normal quite quickly. Monitoring the PTH level during surgery allows the surgeon to be certain that the diseased parathyroid gland was removed. If the level does not return to normal quickly, there may be another diseased parathyroid gland that needs to be removed, which can be done during this initial surgery.

View information about the risks of surgery and how to prepare for surgery.

More Information

For more information, please contact our office at 410-328-6187.