Parathyroid

 

Functions

The parathyroid glands are responsible for the production of parathyroid hormone which regulates the calcium metabolism in the body. Parathyroid hormone has a direct influence on bone calcification and kidney function. An overproduction of parathyroid hormone by the parathyroid glands increases the blood calcium level to a degree which might cause osteoporosis or kidney stones. 

 

Location

The four parathyroid glands have a very close anatomical relationship to the posterior part of the thyroid gland. If not enlarged, they have the size of a pea. 

 

Diseases of the Parathyroid Glands:

Primary hyperparathyroidism is mostly caused by a solitary parathyroid adenoma. Symptoms include functional disorders of the kidneys (kidney stones, kidney insufficiency), disorders of bone metabolism (osteoporosis, bone pain), as well as sadness and depressive episodes. In rare cases of hereditary endocrine neoplasia (MEN) syndromes, primary hyperparathyroidism is developed, too.

Secondary hyperparathyroidism is a functional disorder of all of the four parathyroid glands due to a serious chronic kidney insufficiency.

 

Indications for Surgery?

• High blood (serum) calcium of over 2,8 mmol/l
• Evidence of reduced bone density caused by hyperparathyroidism
• Occurrence of kidney stones caused by hyperparathyroidism

 

Surgical Therapy

Parathyroid operations are always performed under general anesthesia. In order to avoid a functional disorder of the vocal cord nerves, so called neuromonitoring is used check their functions during the operation. In primary hyperparathyroidism, based on the information obtained from ultrasound and scintigraphy, the surgeon is able to remove precisely the enlarged parathyroid adenoma in patients with primary hyperparathyroidism. Ten to 15 minutes after the removal of the adenoma, a lab test to evaluate the parathyroid hormone level is performed, which must show a decrease into the normal PTH level. As soon as the pathologist has verified that a parathyroid adenoma has actually been removed by frozen section, the operation is ended. In certain cases the removal of a parathyroid adenoma can be performed as an open minimally invasive procedure with an incision of only 3 cm. The responsible doctors will discuss the pros and cons of the various surgical procedures with you previous to your surgery.

 

In the case of secondary hyperparathyroidism, all four parathyroid glands will be removed. To maintain calcium metabolism a part of a parathyroid gland will be replanted in the thigh.

 

Complications

Even in specialized centres with very precise surgical techniques, there are rare cases which suffer complications following parathyroid surgery.

 

Paresis of the recurrent laryngeal nerves

Damage to just one side of the recurrent laryngeal nerves results in hoarseness. Damage to both sides results in a toneless voice and difficulties with swallowing. The reason for the loss of function of the vocal cord nerves is rarely, due to a cutting of the nerves but due to a functional disorder from pressure or stretching.

 

Functional disorders of the parathyroid glands

In operations where all four parathyroid glands have been removed, with replantation of a part of a gland, there can be a temporary calcium deficiency, causing cramps. These symptoms are treated with calcium pills

 

Aftercare

For the first few hours after parathyroid surgery, your cardiovascular parameters will be monitored, bandages and drainage tube are checked, and your calcium levels will be checked. On the day after surgery, the drainage tube is removed, on the second day after surgery an ear-nose-throat examination is done to check the recurrent laryngeal nerves, and on the third or fourth day after surgery the stitches will be removed. Before being released you will have a final appointment with the doctor to discuss the results of the pathological examination and future treatment. Any further care is done by your family doctor, endocrinologist or nephrologist.

 

Main focus of research of endocrine surgery - parathyroid

Management of a multicenter study to examine the quality of life and psychological changes of patients with primary hyperparathyroidism pre-and postoperatively.

 

Consultations

Consultation for endocrine surgery is once a week on Wednesdays at the University of Heidelberg Hospital for Surgery from 13:30-15:30. The consultations are done in cooperation with an endocrine surgeon and an endocrinologist.

To make an appointment, please call in advance. Contact person is Mrs. Carolin Galm (Tel: 06221-56-36217)

 

Should you have further questions or prefer e-mail contact it would be our pleasure to answer these:

carolin.galm(at)med.uni-heidelberg.de