The parathyroidectomy is the surgical removal of one or more parathyroid glands. The parathyroids are small glands (3-5 millimeters), located behind the thyroid and producing parathyroid hormone (PTH) — responsible for regulating calcium in the blood and bones.

When is surgery needed?

The most common cause is parathyroid adenoma, a benign hyperplasia that causes:

• hyperparathyroidism,
• increased levels of parathyroid hormone (PTH),
• high calcium in the blood.

This can lead to serious complications:

• nephrolithiasis,
• osteoporosis,
• cardiac arrhythmias.

Diagnosis

Diagnosis begins with blood tests for elevated calcium and parathyroid hormone (PTH).

The adenoma is detected by:

• parathyroid scintigraphy,
• high-definition ultrasound.

Preoperative Localization

The ultrasound localization by the surgeon himself before surgery is critical for:

• minimally invasive technique
• precise removal of the adenoma
• preservation of the recurrent laryngeal nerve and surrounding structures

Precision Techniques

During surgery, the following are applied:

• magnification with surgical loupes
• Neuromonitoring of the recurrent laryngeal nerve
• use of parathyroid camera, when necessary.

Note: Parathyroid adenomas rarely emit autofluorescence, so they are not always detected with the special camera.

Intraoperative Parathyroid Hormone Measurement

The parathyroid hormone measurement during surgery offers:

• immediate laboratory confirmation of complete removal of the adenoma,
• possibility of immediate correction, if necessary,
• In difficult cases, a rapid biopsy is also performed by the pathologist.

In conclusion

Successful and safe removal of adenoma is based on:

• at the precise ultrasound location,
• in surgical experience and precision
• in the use of modern techniques and technologies

Professor Mr. Psychogios, specialized in Thyroid & Parathyroid Surgery and Cervical Ultrasound, undertakes diagnosis and treatment, always in close collaboration with your endocrinologist .