Parathyroidectomy

Parathyroidectomy is a surgical procedure to remove one or more diseased parathyroid glands to cure hyperparathyroidism. This condition is characterized by excessive parathyroid hormone (PTH) production, leading to elevated blood calcium levels. The surgery is typically performed under general anesthesia as an outpatient procedure, with patients discharged the same day.

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Primary Hyperparathyroidism

Primary hyperparathyroidism is a common endocrine disorder, affecting nearly 1% of the population. It is the third most common endocrine disorder after diabetes and hypothyroidism, and is 2.5 times more common in women than in menThe condition's prevalence increases significantly for individuals aged 70 and older.

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Causes and Diagnosis

• Most often caused by a benign tumor in one or more parathyroid glands
• Less frequently caused by thickening of all parathyroid glands
• Diagnosed through blood tests showing elevated calcium and parathyroid hormone levels

Diagnosis can be challenging and often delayed due to borderline calcium elevations and vague symptoms that may be mistaken for other conditions.

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Secondary Hyperparathyroidism

Secondary hyperparathyroidism occurs when PTH production increases in response to chronically low calcium levels, often due to kidney disease or Vitamin D deficiency. While initially a normal physiological response, chronic stimulation can lead to diseased parathyroid glands requiring surgery.

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Pre-Surgical Evaluation

Once diagnosed, patients typically undergo:

• Neck ultrasound to evaluate parathyroid and thyroid glands
• Possible additional imaging studies (parathyroid scan, neck CT, or MRI)

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Surgical Procedure and Outcomes

Parathyroidectomy is performed through a small neck incision, with traditional open surgery preferred over scarless approaches. The surgical cure rate for hyperparathyroidism is 97% to 99% with appropriate workup and intraoperative assessment.

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Benefits of Parathyroidectomy

1. Improved mental and cognitive health
2. Enhanced bone health
3. Improved kidney function
4. Better heart health
5. Enhanced quality of life (reported by 70% of patients post-surgery)

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Post-Surgical Expectations

After parathyroidectomy, patients may experience:

1. Low calcium symptoms (numbness, tingling, muscle cramps) typically lasting a few days
2. Possible voice changes due to nerve injury (usually temporary)
3. Rare risk of neck bleeding (a potentially serious complication)
4. Persistent hyperparathyroidism in a small percentage of cases

Parathyroidectomy is generally a safe and effective treatment for hyperparathyroidism, offering significant improvements in various aspects of health and quality of life for most patients.