Procedures
Parathyroid Glands
General information about parathyroid glands
Parathyroid glands are the size and color of lentils and are found on the posterior surface of the thyroid glands in most of them. However, they are usually 4 but the number differs in a small percentage, as is their anatomical position, and can be found either in the thyroid, thymus or mediastinum.
Parathyroid secretes parathyroid hormone, a hormone that regulates calcium levels in the blood (bone absorption, kidney reabsorption and increased intestinal calcium absorption of food).
Primary Hyperparathyroidism
In primary hyperparathyroidism we have elevated parathyroid hormone and serum calcium and low phosphorus levels.
Causes:
- single adenoma (80%)
- double adenoma about (5%)
- hyperplasia of most glands involving approximately (15%) and that can often occur in patients with multiple endocrine neoplasia (MEN) syndrome
- parathyroid gland cancer very rare (1%)
Secondary Hyperparathyroidism
In secondary hyperparathyroidism we find elevated parathyroid hormone levels with low serum calcium levels while phosphorus levels are elevated.
Causes:
- Chronic vitamin D deficiency
- Renal failure
- Malabsorption syndromes
Tertiary Hyperparathyroidism
In tertiary hyperparathyroidism we have the development of autonomous parathyroid tissue in secondary one.
Parathyroid gland surgery
The surgical treatment of primary hyperparathyroidism depends on the cause.
- Single parathyroid adenomas
In this case, our goal is to exclude the affected parathyroid that has developed the adenoma. Preoperatively this should be diagnosed by 2 imaging methods (ultrasound and scintigraphy) in order to be removed locally in the operating room. An important aid during surgery is the measurement of parathyroid hormone. If the hormone drops to the desired level, the operation is considered to have been successfully completed. Otherwise we have to go through our incision and look for the other parathyroid glands and find out which ones are pathological in order to remove them.
- Multiple gland disease:
In this case, the goal of surgery is to find and remove all pathological parathyroid glands (the pathology may involve either hyperplasia or adenomas in one or more parathyroid glands). The purpose of the surgery is to remove the abnormal parathyroid tissue and maintain a parathyroid tissue capable of causing permanent hypoparathyroidism in the patient.
- Parathyroid gland cancer:
In this case, our goal is to exclude the affected parathyroid who has developed the carcinoma along with removal of the thyroid lobe and extensive lymphadenectomy in the surrounding area.
Thyroid / Parathyroid Surgery
- Total Thyroidectomy or Lobectomy for benign or malignant thyroid disease
- Lymph node dissection Central or Lateral ( for Thyroid Cancer)
- Parathyroidectomy. Removal of parathyroid gland tumors
- Thyroglossal duct cyst
