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Parathyroid glands are composed of four glands as big as peas. They are located at the back of the thyroid gland in the neck. In some cases, parathyroid glands are buried in the thyroid, thymus or chest. Although the location may vary, their functions are generally normal.

Minimally invasive surgery for hyperparathyroidism, including endoscopic parathyroidectomy and unilateral neck exploration under local anesthesia, is performed for primary hyperparathyroidism from single parathyropathy. Minimally invasive parathyroid surgery is not suitable for those with secondary hyperparathyroidism due to multi-glandular lesions.

Parathyroidectomy applies to:

• Primary hyperparathyroidism: If found, the enlarged glands must be removed.
• Secondary hyperparathyroidism: Currently, most of the surgical methods are subtotal parathyroidectomy or total parathyroidectomy plus partial autologous transplantation.
• Multiple endocrine neoplasia: Excise the hyperplastic glands and look for other concomitant tumors.

Surgery Effects

• Surgical resection of the parathyroids is usually the most direct and effective treatment for symptomatic hyperparathyroidism. But at least 20% of asymptomatic patients still require surgery.
• Secondary hyperparathyroidism can cause skeletal, muscular, neurological, and even cardiovascular symptoms such as limb pain and weakness, bone soreness, itchy skin, and even cardiovascular obstruction.

Surgical Risks

The following complications and risks may occur during parathyroidectomy:

• The incidence of postoperative wound infection is less than 1%.
• Edema or bruising appears near the wound after operation.
• Postoperative bleeding causes hematoma, which mostly occurs within 2 to 4 hours after surgery, but may occur within dozens of minutes after surgery. When the hematoma is too large, it sometimes causes dyspnea and must be treated urgently. The incidence is less than 1%.
• Unilateral recurrent laryngeal nerve paralysis may result in hoarseness of voice. Bilateral recurrent laryngeal nerve paralysis can cause dyspnea; the incidence is about 1%.
• Paralysis of the superior laryngeal nerve results in the inability to produce high-pitched sounds.
• Postoperative hypocalcemia or parathyroid gland dysfunction may lead to limb numbness or cramp. Calcium should be supplemented. It is more common, but often temporary.
• Although the success rate of secondary hyperparathyroidism surgery is high, persistent or recurrent hypercalcemia still can be found in 2 to 12% of patients after surgery. The main reasons for failure are as follows:
  • The rupture of the glands during surgery results in the spread of parathyroidoma.
  • All four parathyroids could not be found.
  • More than 4 parathyroids or ectopic parathyroids are located in the mediastinum.
  • These patients who have failed their first surgery still have a chance of succeeding with a second.

Postoperative Care

• Track parathyroid hormone levels regularly and supplement calcium if necessary.