ParathyroidectomyThe parathyroid glands are small glands in the neck which secrete parathyroid hormone which is important in regulating the level of calcium in the blood. They are essential for normal health. A parathyroidectomy is a procedure to partially or totally remove the glands. Reasons for doing this surgery may include a mass or tumor involving one or more of the glands (adenoma or adenocarcinoma) or due to overactive glands (hyperplasia) both of which cause hyperparathyroidism and hypercalcemia (elevated calcium in your blood). The procedure is performed at the hospital under general anesthesia. The extent of the surgery depends on the underlying pathology. If there is a mass of unknown type involving one gland, then that entire gland is removed and immediately sent to the pathologist who renders a preliminary diagnosis. Adenomas are benign lesions, and there can be more than one. Adenocarcinomas are malignant, but are very rare. Once removed, the cure rates are very high. Typically one or two of the glands may be involved, but the other glands are left alone. Hyperplasia on the other hand requires a more extensive surgery by searching on both sides of the neck for all of the glands. Usually, one half of the gland is left behind in order to provide some function to regulate calcium. Special mention is made to important structure near the parathyroid glands, the recurrent laryngeal nerves to the voice box. The recurrent laryngeal nerves pass from the brain, down the neck along the large arteries, and then turn around and come back up along the windpipe and thyroid gland before reaching the larynx where they control the motion of the vocal cords on each side. These nerves will be identified and kept safe throughout the procedure. Rarely, tumors invade these nerves necessitating their resection. Dr. Speyer will discuss the risks, benefits, and alternatives to this procedure with you in detail. Listed below are some of the disclosed risks of undergoing a parathyroidectomy. By reading and signing below, you are stating that you indeed understand the nature of the procedure, the risks as listed, and alternatives to undergoing the procedure. Risks of parathyroidectomy include, but are not limited to, bleeding, infection, recurrent laryngeal nerve weakness or paralysis resulting in difficulty with voice and swallowing which may be temporary or permanent. Additional therapy and/or surgery would be recommended. In rare instances, both nerves are injured requiring a tracheotomy, which may be temporary or permanent. Malignancies carry the risk of recurrence, failure to clear all of the margins with residual tumor left behind, and the need for additional treatment. There is a risk of temporary or permanent hypocalcemia. If a neck dissection is performed as well, this carries with it additional risks of nerve injury, shoulder dysfunction, chyle leak, damage to surrounding veins and/or arteries. All incisions carry the risk of scarring or keloid formation, which will be minimized by hiding the incision in a skin crease and using fine sutures to result in the most acceptable cosmetic outcome. Lastly, since you are undergoing a general anesthetic, this alone carries its own risks regardless of the surgery considered. The risks of general anesthesia include, but are not limited to, the risk of heart attack, stroke, drug reactions, and even death. You should discuss your specific risks assessment with the anesthesiologist during your preoperative anesthetic appointment.
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