The parathyroid glands are four small glands located in the neck. They regulate the amount of calcium in the blood. If the glands are over-functioning, an individual may need surgery to remove one or more glands.

Doctors may refer to surgeries that involve removing one or more parathyroid glands as a parathyroidectomy. There are several reasons that parathyroid gland removal may be necessary, as well as various approaches to removal. One reason for this surgery is hypercalcemia, a condition in which there is too much calcium in the blood.

Read on to learn more about parathyroid removal, including the different types, associated risks, what to expect, and outlook. This article also answers some frequently asked questions on the topic.

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There are several approaches to parathyroid gland removal, explained below.

Bilateral neck exploration

This traditional removal technique involves a surgeon manually exploring each of the four glands to assess which needs removing.

Bilateral neck exploration usually involves an incision in the middle to lower neck and takes around 90 minutes. Surgeons most commonly use this method when they cannot identify which gland or glands require removal before the procedure.

Focused parathyroidectomy

Experts consider focused parathyroidectomy to be minimally invasive. Surgeons can identify diseased glands beforehand using preoperative localization studies such as a parathyroid ultrasound or sestamibi (radionucleotide) scan.

Focused parathyroidectomy involves a smaller incision and generally causes less discomfort than a bilateral neck exploration.

Surgeons use a technique called intraoperative monitoring to check parathyroid hormone (PTH) levels during surgery and assess whether the removal was enough or whether another gland may need removing at the same time.

Radio-guided parathyroidectomy

This procedure is a type of focused parathyroidectomy in which the surgeon uses radioactive materials to identify the diseased gland.

A healthcare professional uses a sestamibi scan, which involves injecting a radioactive solution into the body. This solution gathers in the affected gland, and the surgeon uses a handheld gamma probe to locate it.

Four gland hyperplasia

In the rare case that all four parathyroid glands are enlarged — known as parathyroid hyperplasia — the surgeon may remove three entire glands and half of the remaining gland. They may either leave the remaining gland tissue intact or transplant it to the forearm. This helps prevent PTH from dropping too low.

Hyperparathyroidism is the most common condition related to the parathyroid glands. This condition occurs when one or more parathyroid glands produce too much PTH, causing the calcium level in the blood to rise.

Too much calcium in the blood can lead to the following conditions:

Most people with primary hyperparathyroidism tend not to have symptoms. However, some may experience the following:

In cases of more severe disease, a person may experience:

A benign tumor, or adenoma, growing in one or more of the parathyroid glands can also cause it to become enlarged.

All surgical procedures have associated risks. These include the potential for:

Parathyroid removal surgery is typically safe and does not have many associated risks. Some of the risks associated with these procedures include:

  • Bleeding from the neck: It is rare to bleed enough after a parathyroidectomy to put a person at risk. If there is significant bleeding from the neck, it can make breathing difficult. Healthcare professionals will monitor bleeding after surgery.
  • Recurrent laryngeal nerve injury: The parathyroid glands sit close to the recurrent laryngeal nerves that control the vocal cords. This means surgery in this area can cause temporary hoarseness, vocal weakness, and a tiring voice. This typically goes away after a few weeks but can last up to 6 months or, in rare cases, be permanent and require medical intervention.
  • Temporary hypocalcemia (hypoparathyroidism): This refers to a reduced amount of calcium in the blood. It can happen due to the parathyroid glands not functioning correctly after surgery. A doctor may prescribe calcium supplements after surgery.

Before a parathyroidectomy, a surgical team will determine which approach they will take and which gland or glands require removal. This may involve a range of tests, such as:

  • sestamibi scan, which can help identify any atypical features within the parathyroid glands
  • SPECT scan, which can provide functional images of the parathyroid glands and other structures in the body
  • CT scan
  • neck ultrasound
  • MRI scan

In preparation for the procedure, a person should follow the guidelines set by the doctor in charge of their care. This might include not taking any over-the-counter pain medications for around 1 week before the procedure and avoiding eating in the hours before it takes place.

A person will typically receive general anesthesia for parathyroid gland removal so they will remain unconscious throughout the procedure.

Individuals receiving this surgery lay face up with their neck extended and arms by their sides.

The exact method of the procedure will depend on which approach a surgeon is using. For example, a focused parathyroidectomy involves a smaller incision and shorter procedure time than a bilateral neck exploration, which typically takes around 90 minutes.

An individual may return home the same day of a parathyroid removal surgery or spend a night in the hospital. Recovery times may vary, but most people can get up and walk around within 1–2 days and return to typical activities after around 1 week.

Generally, people may experience some pain and discomfort after the procedure. A doctor may recommend acetaminophen (Tylenol) or other pain-relieving medications.

A doctor will monitor a person’s calcium and vitamin D levels for 6 months after the procedure. They may prescribe calcium and vitamin D supplements if levels become too low.

Parathyroidectomy removal is an effective cure for hypercalcemia, and success rates can be as high as 99%, depending on the type of surgery. It is rare for hypercalcemia to return after parathyroidectomy.

Below are some commonly asked questions about parathyroid removal surgery.

Is parathyroid removal a major surgery?

Parathyroid removal surgery is not a major surgery. This procedure typically involves a small incision and minimal recovery time. Some parathyroidectomy methods are minimally invasive and take around 20 minutes.

Can a person live without a parathyroid gland?

Yes. There are four parathyroid glands in the body, and a person only needs part of one to maintain the necessary level of calcium in the blood.

Most people who have parathyroid removal surgery only need one gland removed. It is very rare for a person to have no remaining parathyroid glands. When this is the case, it can cause ongoing health issues that may require lifelong treatment.

Parathyroid removal surgery, or a parathyroidectomy, is a minor surgery to remove the parathyroid glands. Doctors may recommend surgery when there is too much calcium in the blood (hypercalcemia). An adenoma is likely to be a reason behind an elevated calcium level.

This surgery has a very high success rate, and some experts consider it a cure for hypercalcemia. This procedure will likely have minimal risk and recovery time, with some approaches to removal being minimally invasive.