Parathyroid Surgery

What is the Parathyroid?

The parathyroid glands are four pea-sized glands located on the thyroid gland in the neck. Though their names are similar, the thyroid and parathyroid glands are entirely different, each producing distinct hormones with specific functions.

The primary function of the parathyroid glands is to regulate calcium levels in the blood, which is crucial for various bodily functions, including muscle contraction and nerve signaling.They achieve this through the parathyroid hormone (PTH), which they produce.

Hyperparathyroidism (Parathyroid Gland Dysfunction)

Symptoms of hyperparathyroidism include:

• Fragile bones (osteoporosis)
• Excessive urination
• Kidney stones
• Easily tired
• Bone and joint pain
• Depression or forgetfulness

Hyperparathyroid Treatment

The most common parathyroid condition is called hyperparathyroidism. This disorder occurs when one or more of the parathyroid glands produce excessive amounts of PTH, resulting in elevated calcium levels in the blood (hypercalcemia).

If untreated, hyperparathyroidism can lead to serious complications like osteoporosis (weakening of bones), kidney damage, and cardiovascular issues due to prolonged high calcium levels in the blood.

Symptoms of Hyperparathyroidism

Many individuals with primary hyperparathyroidism may not experience symptoms initially. However, when symptoms do occur, they can include:

• Fragile bones (osteoporosis)
• Excessive urination
• Increased thirst
• Kidney stones
• Easily tired
• Bone and joint pain
• Depression or forgetfulness

Hyperparathyroidism Diagnosis in Metro Atlanta

If you or your doctor suspect there’s something off with your parathyroid gland, your doctor might order some or all of the following tests. At Northwest ENT, Dr. Parikh uses multiple tests to diagnose hyperparathyroidism, depending on the complexity of your case.

Blood Test

One of the first tests used to diagnose hyperparathyroidism is a blood test. If you are having symptoms associated with hyperparathyroidism, your ENT doctor will order a blood test to check your calcium and PTH levels.

In some cases, patients who are not showing symptoms will take a blood test for other reasons and find out they have elevated calcium levels. In this case, your ENT doctor will order additional bloodwork to confirm the calcium levels and check the PTH level as well.

Urine Test

A sample of your urine will be tested to determine whether your kidneys are working as expected and what the calcium levels in your urine are. A urine test can point towards kidney disorder as the cause of hyperparathyroidism, or help determine how severe the  hyperparathyroidism is depending on how high the calcium levels in your urine are.

Parathyroid Gland Imaging Tests

If surgery is being considered or if there is uncertainty about which gland is overactive, further imaging studies may be performed:

• Ultrasound: This is often the first-line imaging test to locate abnormal parathyroid glands. The ultrasound uses high-frequency sound waves to create images of the parathyroid glands and the surrounding tissue.
• Sestamibi Scan: This medical test is designed to find overactive parathyroid glands. Sestamibi is a compound which helps locate overactive parathyroid glands. The compound is injected into a vein. Then, a scan is performed to detect where the sestamibi has accumulated and find the overactive gland.
• 4D CT Scan: A more advanced imaging technique that provides detailed information about the parathyroid glands. If other imaging studies do not clearly identify the problematic gland(s), a 4D parathyroid CT scan may be employed as a follow-up to provide more detailed information, as the procedure has proven highly accurate in identifying abnormal glands.

Hyperparathyroidism Treatment in Metro Atlanta

If you have been diagnosed with primary hyperparathyroidism, you will likely need surgery and may need to have one or more parathyroid glands removed. At Northwest ENT, we offer parathyroid surgery to patients in the Metro Atlanta area.

If Dr. Parikh is able to get an accurate image of the problem area, typically via ultrasound, then they will opt for a Minimally Invasive Parathyroidectomy (MIP), where they can remove the thyroid gland(s) through a well-placed small incision. An MIP is also known as a direct parathyroidectomy, and is becoming increasingly common. At NW-ENT, 95% of our parathyroid surgeries have qualified for an MIP procedure.

If the imaging studies have been inconclusive or multiple glands are suspected to be involved, your surgeon might need to perform a Bilateral Neck Exploration (BNE).

Minimally Invasive Parathyroidectomy (MIP)

MIP is a modern surgical approach to parathyroidectomy designed to remove overactive parathyroid glands while minimizing trauma to the surrounding tissues. The procedure presents several advantages compared to traditional parathyroidectomy.

Benefits of Minimally Invasive Parathyroidectomy

There are a few key differences between MIP and BNE that impact the patient experience:

• Small Incision: Instead of making a large cut in the neck, MIP involves a small incision, usually about 1.5 to 2 centimeters long, made in a natural skin fold. This results in less visible scarring.
• Light Anesthesia: The surgery can often be performed under reduced anesthesia, which reduces recovery time.
• Quick Operation: The entire procedure typically takes less than 20 minutes. Surgeons use imaging studies done before the surgery to locate the abnormal gland(s) accurately.
• Faster Recovery: Most patients can go home within 1 hour after the procedure and often return to normal activities quickly—typically within a few days.

Watch Dr. Shatul L. Parikh explain MIP here:

Bilateral Neck Exploration

Bilateral neck exploration is a surgery where the surgeon looks at both sides of the neck to find and remove overactive parathyroid glands.

Before the surgery, the patient is usually placed under general anesthesia, ensuring the patient is asleep and pain-free during the entire procedure. Then, the surgeon makes an incision in the neck to access the parathyroid glands. The surgeon carefully examines all four parathyroid glands to identify which ones are enlarged or overactive. Glands that meet these criteria will be removed. After removing the necessary glands, the incision is closed with stitches.

Recovery after Bilateral Neck Exploration

After surgery, patients are usually monitored in the recovery room for a 1 hour to check for any immediate complications, such as bleeding or difficulty breathing.Patients are encouraged to rest but can generally start walking around the same day or the next day after surgery.

Most patients can return to office jobs within 3 days after surgery.If your job involves heavy lifting or strenuous physical activity, it may take longer to return, often up to 1 week after surgery.

Post-Surgery Care after Parathyroidectomy

After parathyroid surgery, patients may experience a temporary drop in calcium levels, known as "hungry bone syndrome". Your parathyroid specialist will monitor and manage your calcium levels during recovery. Patients may require calcium supplements or other interventions if hypocalcemia occurs.

Experienced Parathyroid Surgeons in Georgia

At Northwest ENT, Dr. Parikh is ready to diagnose, treat and monitor parathyroid dysfunction. With three locations in the Metro Atlanta area, we are here to provide the care you need to normalize your calcium levels and improve your life quality.