Parathyroid (parathyroid, parathyroid) glands are endocrine organs located in the upper and lower poles on the posterior surface of the thyroid gland. They produce parathyroid hormone (PTH), which regulates the amount of calcium in the body. Removal of the parathyroid gland is indicated for hyperparathyroidism , adenoma, multiple endocrine neoplasia syndrome, etc. Surgical treatment prevents dangerous complications – hypercalcemia, urolithiasis, renal failure.

When it is necessary to remove the parathyroid glands

Parathyroid glands – 4 endocrine glands, which are localized in pairs in the upper and lower poles of the thyroid gland. They synthesize parathyroid hormone, which regulates serum calcium concentration. Its excess leads to disturbances in the work of the musculoskeletal, endocrine and nervous systems.

With a strong increase in the level of PTH in the blood, hypercalcemia occurs, which is fraught with musculoskeletal, gastrointestinal, renal and cardiovascular syndromes:

• stomach ulcer;
• laryngeal paresis;
• renal acidosis;
• urolithiasis disease;
• pancreatitis;
• arterial hypertension, etc.

The operation is recommended for tumors of the parathyroid glands, the formation of hormone-active neoplasms in them . Removal of endocrine organs is carried out when:

• hyperparathyroidism ;
• adenoma;
• hereditary glandular hyperplasia;
• hyperparathyroid crisis;
• malignant tumors.

Most often, the operation is performed due to excessive production of parathyroid hormone against the background of hyperparathyroidism . Due to the violation of mineral metabolism, the kidneys and bone tissue are primarily affected. Pathology is complicated by osteodystrophy, renal colic, osteoporosis.

Temporary contraindications for surgery are:

• infectious diseases;
• pyelonephritis;
• bleeding from the gastrointestinal tract.

Surgical treatment of the parathyroid glands is postponed until the condition stabilizes.

Preparing for surgery

The operation on the parathyroid gland is performed after a comprehensive examination. Based on the data of laboratory and instrumental studies, the doctor determines the appropriate method of surgery.

Preoperative diagnosis consists of the following procedures:

• Ultrasound, MRI of the neck. The condition of the parathyroid glands is assessed, tumors are detected, and their localization is determined.
• Scintigraphy. Thallium-technetium is injected into the body, which is captured by the cells of the parathyroid glands. The obtained images determine the degree of hormonal activity of the tumors.
• Blood chemistry. The hyperactivity of the parathyroid glands is indicated by an increased concentration of parathyroid hormone and calcium.
• Biopsy. If cancer is suspected, a fine-needle biopsy is performed followed by histological tissue analysis.

According to the results of the diagnosis, the doctor excludes malignant neoplasms. In preparation for the operation, the functional state of other organs is determined. To assess their health, echocardiography, ultrasound of the kidneys, and X-ray of the esophagus are performed.

Types and methods of removing the parathyroid glands

The choice of surgery depends on the location, type and size of the growths in the parathyroid glands. At the preoperative stage, drug correction of hypercalcemia is performed.

In case of benign formations, they resort to partial resection (removal), and in case of malignant ones, to total excision of the glands together with regional lymph nodes.

Open and endoscopic methods

Parathyroidectomy is a surgery to remove the parathyroid glands. The amount of surgery depends on the degree of damage to the glandular tissue. In most cases, the surgeon resorts to open or endoscopic surgery. In the first case, access to the organ is through the neck:

• under anesthesia, an incision up to 80 mm long is made along the lower fold of the neck;
• with layer-by-layer separation of tissues on the posterior surface of the thyroid gland, an adenoma is found;
• the tumor is carefully separated from the healthy parts of the gland and excised.

After open surgery, the level of parathyroid hormone in the blood is determined. A decrease in its concentration indicates a successful treatment.

With small neoplasms on the parathyroid glands, they resort to minimally invasive operations using endovideo technology :

• 3 punctures are made on the neck;
• gas is injected under the skin for more convenient access to the parathyroid glands;
• trocars (hollow tubes) are inserted into skin punctures;
• a video camera and cutting tools are introduced into them;
• under the control of a video camera, the tumor is excised.

Endoscopic surgery is performed with a precisely confirmed diagnosis, the absence of goiter.

Incomplete and complete resection

Partial or subtotal parathyroidectomy is an operation to remove the parathyroid gland while preserving a part (no more than 50 mg) of the glandular tissue. With hypertrophy of both pairs of organs, three glands are removed, and a small piece is left from the fourth. During the rehabilitation period, the calcium content in the blood is monitored. If it is not enough, maintenance drugs are prescribed.

A total operation to remove four parathyroid glands is performed when:

• cancerous growths;
• adenomatosis ;
• secondary hyperparathyroidism ;
• syndrome of multiple endocrine neoplasias.

Sometimes parathyroidectomy is prescribed when pills are not effective for treating hyperparathyroidism .

After the operation, the glandular tissue is sent for histological analysis. If there are no signs of hyperplasia, a fragment of the parathyroid gland is implanted into the muscles of the forearm.

Other techniques

According to indications, the treatment of the parathyroid glands is carried out by other methods:

• Palliative destruction of neoplasms. The essence of the method is the introduction of drugs with ethyl alcohol inside the gland. They damage the glandular tissue, as a result of which it is replaced by connective tissue fibers. As a result, the hormonal activity of the parathyroid glands decreases.
• Surgery to remove endocrine organs with lymph node dissection . With cancerous growths, not only the affected glands are excised, but also regional lymph nodes.

To prevent the recurrence of malignant tumors, radiation therapy is performed, which is aimed at destroying the remaining cancer cells in the body.

Possible consequences of the intervention

Other anatomical structures are located near the parathyroid glands – the thyroid gland, recurrent nerve, arteries, etc. Their damage causes serious postoperative complications.

The consequences of removing the parathyroid gland in women and men:

• bleeding from an operating wound;
• hoarseness of voice;
• muscle cramps;
• violation of mineral metabolism;
• infectious inflammation of the operated tissues;
• leaching calcium from bones (osteoporosis);
• paralysis of the vocal cords.

If all four parathyroid glands are accidentally removed during the operation, it leads to hypocalcemic crisis and death.

Complications after surgery are extremely rare. But to prevent negative consequences, you need to periodically take an analysis for parathyroid hormone. Its deficiency is fraught with hypoparathyroidism , which is accompanied by the following symptoms:

• vomiting;
• loose stools;
• pain in the region of the heart;
• depressive state;
• laryngospasm;
• decreased memory;
• violation of the act of swallowing;
• dry skin;
• feeling hot;
• hair loss.

Local recurrences of malignant tumors after surgery occur in 50% of cases. Therefore, within 1-3 years, the operated patients should be examined by an endocrinologist at least once every six months.

Recovery after surgery

For 1-5 days after the operation, patients are in the hospital under the supervision of a doctor. With a high risk of complications, you need to stay in the hospital even longer.

Features of rehabilitation after removal of the parathyroid glands:

• Medical care. Within 3 days, the medical staff monitors the patient’s condition – his ability to swallow, talk. As it gets dirty, change the bandage around the neck, pretreating the seams with antiseptic drugs.
• Home care. After discharge, the patient must strictly follow the doctor’s recommendations – take calcium supplements, PTH substitutes, antibiotics. For 1-2 weeks, they follow a sparing diet with restriction of solid food, fatty meat.

After the operation, they refuse to visit solariums, baths, limit exposure to the sun, physical activity.

Indications for repeated visits to the doctor:

• numbness of facial muscles;
• difficulty swallowing;
• purulent inflammation of the surgical wound;
• muscle cramps;
• feverish condition;
• high body temperature;
• tachycardia;
• excessive sweating;
• sleep disorders;
• tingling sensations in the upper limbs.

If you feel worse, you need to make an appointment with a doctor. Convulsions and tingling sensations in the muscles indicate a deficiency of parathyroid hormone in the blood, the need for correction of drug therapy.

How to live without parathyroid glands

After the operation to excision the parathyroid glands, the production of parathyroid hormone stops. For the prevention of hypocalcemia, calcium-containing drugs are prescribed:

• Calcium-D3 Nycomed;
• Natekal D3;
• Osteogenon ;
• Vitrum Calcium ;
• Complivit Calcium-D3;
• Rocaltrol ;
• Alpha D3 – Teva.

To normalize the mineral balance, they follow a diet that includes foods rich in calcium salts:

• sesame;
• Parmesan;
• hazelnut;
• dairy;
• almond;
• greens;
• sea ​​fish;
• soy.

To compensate for hypocalcemia, they additionally take ammonium chloride and preparations with vitamin D – Solgar , Colecalciferol , Vitamin D3, Alfacalcidol . In order to prevent complications, it is recommended:

• eliminate bad habits;
• observe the drinking regime;
• give up fast food .

After surgery on the parathyroid glands, you need to regularly monitor the level of calcium in the blood.

If medical recommendations are followed, the risk of dangerous complications – urolithiasis, osteoporosis – decreases.

When is glandular transplantation performed?

In the case of total parathyroidectomy, patients are deprived of parathyroid hormone, which leads to:

• violation of the contractile activity of muscles;
• leaching calcium from bones;
• muscle cramps;
• malfunctioning of the myocardium.

For the prevention of complications, therapy is carried out with parathyroid hormone substitutes, multivitamin complexes with vitamin D, calcium. If possible, autologous transplantation of a part of the parathyroid gland into muscle pockets is performed.

Features of glandular tissue transplantation surgery:

• a part of the removed gland is placed in a cryopreservative ;
• frozen tissues are crushed into fragments up to 1.2-1.3 mm in size;
• pockets are formed in the clavicular muscles;
• pieces of the gland are transplanted into the patient’s body.

In rare cases, donor gland transplant surgery is prescribed. But in this case, it is necessary to take cytostatics for a long time to prevent organ rejection.

Prices for surgery in Moscow

The cost of surgical treatment depends on many factors – the type of operation, the qualifications of the surgeon, the volume of surgical interventions.

Operation on the parathyroid glands is performed for cancer, secondary and tertiary hyperparathyroidism , adenoma, multiple neoplasia. The extent of the intervention depends on the degree of damage to the endocrine organs. After total parathyroidectomy, there is a need for lifelong intake of substitutes for parathyroid hormone, calcium and vitamin D. If the endocrinologist’s recommendations are followed, the quality of life does not deteriorate.