Parathyroidectomy-Parathyroid Gland Surgery

Parathyroidectomy is a surgical procedure performed to remove one or more parathyroid glands affected by disease, most commonly parathyroid adenomas causing primary hyperparathyroidism. This condition results in excessive parathyroid hormone (PTH) production, leading to elevated calcium levels (hypercalcemia) in the blood, which can disrupt multiple organ systems. If left untreated, hyperparathyroidism can cause osteoporosis, kidney stones, cardiovascular issues, and neurological symptoms such as fatigue, depression, and cognitive impairment. In severe cases, prolonged calcium imbalance may also contribute to gastrointestinal disturbances, muscle weakness, and arrhythmias, significantly impacting a patient’s quality of life. The procedure may be performed using a minimally invasive or traditional open approach, depending on the number, size, and location of the affected glands, as well as the patient’s overall health.

Why Cuba

In Cuba, parathyroidectomy procedures are meticulously planned and carried out by highly skilled endocrine surgeons to ensure optimal patient outcomes while preserving surrounding structures such as the recurrent laryngeal nerve and remaining parathyroid glands. The country’s reputation for cutting-edge medical expertise and excellence in endocrine surgery allows patients to receive comprehensive preoperative evaluations, precise surgical treatment, and diligent post-operative monitoring to prevent complications and promote a smooth recovery.

Cuban medical institutions offer both traditional open and minimally invasive parathyroidectomy techniques, enabling surgeons to tailor the approach based on the patient’s condition, the number of affected glands, and the complexity of the case.

Importance of the Parathyroid Glands

The parathyroid glands are four small endocrine glands located behind the thyroid. They play a crucial role in:

• Regulating calcium levels in the blood and bones.
• Maintaining neuromuscular function, supporting healthy nerve transmission and muscle contraction.
• Ensuring bone health, preventing osteoporosis and fractures.

Dysfunction of these glands can lead to calcium imbalances, negatively impacting multiple organ systems.

Conditions That Require Parathyroidectomy

Parathyroidectomy is necessary for conditions that cause abnormal PTH production and result in calcium dysregulation. These include:

• Primary Hyperparathyroidism: Overproduction of PTH due to a parathyroid adenoma (benign tumor), hyperplasia (overgrowth of glands), or rarely, parathyroid carcinoma (cancer).
• Secondary Hyperparathyroidism: Occurs in patients with chronic kidney disease, leading to overactive parathyroid glands due to persistent low calcium levels.
• Tertiary Hyperparathyroidism: Develops in patients with long-standing secondary hyperparathyroidism, where the glands become autonomous and continue overproducing PTH despite normal or high calcium levels.

Causes of Parathyroid Disorders

The causes of parathyroid disorders vary depending on the underlying condition, including:

• Parathyroid Adenomas (benign tumors of the parathyroid glands).
• Parathyroid Hyperplasia (enlargement of multiple glands).
• Genetic factors, including multiple endocrine neoplasia syndromes (MEN1 and MEN2).
• Chronic kidney disease, leading to calcium and phosphorus imbalances.
• Vitamin D deficiency, contributing to increased PTH production.

Symptoms of Hyperparathyroidism

Patients with hyperparathyroidism may experience mild to severe symptoms, including:

• Skeletal and Muscular Symptoms: Osteoporosis, bone pain, muscle weakness.
• Renal Issues: Kidney stones, frequent urination, dehydration.
• Neurological Symptoms: Depression, memory problems, confusion.
• Gastrointestinal Distress: Nausea, vomiting, abdominal pain.
• Cardiovascular Effects: High blood pressure, arrhythmias.

Pre-Surgical Diagnosis of Parathyroid Disorders

Before performing a parathyroidectomy, comprehensive diagnostic tests are conducted to confirm the affected glands and assess surgical options. These include:

• Blood Tests: Measuring calcium, PTH, and vitamin D levels.
• Imaging Studies: Used to locate enlarged parathyroid glands.
• Urine Tests (24-Hour Urine Collection): Measures calcium excretion in the urine to differentiate between primary hyperparathyroidism and familial hypocalciuric hypercalcemia (FHH).
• Bone Density Scan: Evaluates bone mineral density.
• Electrocardiogram (ECG/EKG): Assesses potential cardiac effects of calcium imbalances.
• Functional and Neurological Assessments: Tests for neurocognitive impairment, muscle weakness, and psychiatric symptoms that may be linked to chronic calcium imbalance.

These tests help provide a comprehensive evaluation of the condition, guiding treatment decisions and long-term management strategies.

Surgical Options for Parathyroid Disorders

Parathyroidectomy can be performed using minimally invasive or traditional surgical techniques, depending on the number, location, and severity of the affected parathyroid glands. The choice of procedure is influenced by factors such as the presence of a single adenoma, multiple gland disease, or the need for extensive exploration due to unclear imaging results.

Minimally Invasive Parathyroidectomy (MIP) 

• Minimally Invasive Parathyroidectomy (MIP) is the preferred approach when a single parathyroid adenoma has been precisely localized through preoperative imaging techniques.
• MIP approach allows for a highly targeted and less invasive removal of the affected gland, preserving surrounding structures while minimizing surgical trauma.
• The procedure involves making a small incision in the neck, resulting in minimal scarring compared to traditional surgery.
• It can be performed under local anesthesia with mild sedation or general anesthesia, depending on patient preference and medical considerations.

Traditional Open Parathyroidectomy

• Traditional open parathyroidectomy is recommended when multiple parathyroid glands are affected or when imaging results are unclear.
• This approach requires a larger neck incision to provide direct access and visibility to all four parathyroid glands.
• It is performed under general anesthesia and may involve the removal of one or more glands, depending on the severity of the condition.
• Surgeons carefully preserve the recurrent laryngeal nerve and nearby structures to prevent complications such as voice changes or difficulty swallowing.

Bilateral Neck Exploration (BNE)

• Bilateral neck exploration (BNE) is used for complex cases where preoperative imaging has failed to localize the overactive gland(s) or when multiple glands are suspected to be affected.
• The surgeon makes an extensive incision and systematically examines all four parathyroid glands to identify which are abnormal and require removal.
• Because of its exploratory nature, BNE carries a higher risk of complications, such as nerve damage, bleeding, and post-operative hypocalcemia (low calcium levels) due to the possible removal of too much parathyroid tissue.