Parathyroid Surgery

The parathyroid glands are four tiny glands located near the thyroid gland in the center of the neck just above the collar bones. These glands regulate the calcium in the bones and blood stream. Sometimes, one or more of these parathyroid glands becomes overactive, and that is called hyperparathyroidism. The overactive parathyroid(s) release too much parathyroid hormone and cause an increase in blood calcium. The elevated calcium is associated with numerous symptoms and can lead to fractures, kidney stones and osteoporosis. In 80 percent of the cases, just one of the four glands is abnormal or enlarged (called a single adenoma). However, 20 percent of patients will have more than one gland causing a problem (called hyperplasia or multigland disease).

 

UW Health endocrine surgeons in Madison, Wisconsin specialize in treating all types of parathyroid disease including:

  • Primary hyperparathyroidism
  • “Mild” or early hyperparathyroidism
  • Secondary hyperparathyroidism
  • Tertiary hyperparathyroidism
  • Lithium-induced hyperparathyroidism
  • Parathyroid cancer
  • Recurrent hyperparathyroidism
  • Persistent hyperparathyroidism
  • Parathyroid autotransplant

The endocrine surgeons at UW Health specialize in diagnosing all types of parathyroid problems. Patients often spend many months or years suffering before getting the right diagnosis. Therefore, our specialists are committed to helping patients confirm the right diagnosis and get the appropriate treatment so that they can restore their bone health and improve their quality of life.


Each type of parathyroid disease may require slightly different evaluation, imaging and surgical intervention. Your surgeon will indicate the type of parathyroid disease and recommend individualized treatments based on your disease.

 

From Our Surgeons: About Parathyroid Surgery

 

 

Parathyroid Surgery


There are numerous techniques for operating on the parathyroid glands. At UW Health, our endocrine surgeons help patients with parathyroid disease develop a personalized treatment approach using the latest technology and minimally invasive surgical approaches. Our surgeons specialize in a variety of operative techniques including:

 

  • Minimally Invasive Parathyroidectomy: This technique uses a small incision and imaging to locate and remove a single adenoma (one enlarged, abnormal parathyroid gland). Our surgeons utilize intraoperative parathyroid hormone (PTH) testing to confirm that the patient is cured.

  • Bilateral Exploration: This technique has been proven over time to be very safe and effective when performed by an experienced surgeon. This operation involves identifying all four parathyroid glands but removing only those that are abnormal. Our surgeons are experienced at identifying all four glands and use this approach for certain patients who are likely to have multi-gland disease. At UW Health, our endocrine surgeons can perform either a focused or bi-lateral exploration, all through the same tiny incision.
  • Ultrasound-guided parathyroidectomy: Often an ultrasound is the only imaging test required to locate an abnormal parathyroid gland. An ultrasound is a simple test that can be done at the office visit and does not involve any radiation exposure. At UW Health, our surgeons use ultrasounds both in the office and the operating room to enable a small scar.
  • Radioguided parathyroidectomy: As an adjunct to the other surgical approaches, UW endocrine surgeons use a special dye and probe to help locate abnormal parathyroid glands and help decide whether a patient has a single gland or multiple glands causing the parathyroid problem.

  • Re-operative parathyroidectomy: Our surgeons are experienced in treating parathyroid disease after prior operations or when the disease recurs. In our hands, over 98 percent of patients are cured after the first operation, but our surgeons treat patients from all around the world who require reoperative surgery. Using advanced imaging and intraoperative techniques, UW Health can make even reoperative parathyroid surgery safe and curative.


Our surgeons will often use a combination of these techniques for each patient. We strive to create a personalized, tailored approach for the patient depending on their specific parathyroid problem and individual preferences in order to ensure a lasting cure. Our providers are committed to the total care for parathyroid disease. This includes ensuring each patient is taking the proper amount of calcium, vitamin D and mineral supplements before and after surgery. We are also committed to ensuring that each patient remains cured. We continue to follow our patients for at least six months after surgery.


Parathyroid Cancer


Most enlarged parathyroid glands are benign (non-cancerous) growths. In less than one percent of cases, the abnormal parathyroid gland is actually a cancer. While occasionally a biopsy may be performed in the operating room to confirm the presence of cancer, this is rarely done. In most cases, the diagnosis of cancer is based on the outside appearance of the tumor, not its microscopic findings. Our surgeons usually know when the parathyroid tumor is likely a cancer and will ensure the patient is treated for cancer when that is necessary. Regardless of the diagnosis, parathyroid tissue that is removed during surgery is always sent to the pathologist to confirm that it is benign or malignant.


Parathyroid Autotransplantation


For certain types of hyperparathyroidism or reoperative parathyroid surgery, your surgeon may decide to place part of the parathyroid tissue that is removed back into a patient, creating a tiny pocket in the muscles of the forearm. This procedure is done to ensure that the patient still has enough healthy parathyroid tissue to maintain calcium levels. Our surgeons are experienced with this particular technique.


Genetic Testing


Sometimes parathyroid problems can run in families, either as an isolated parathyroid problem or part of a genetic syndrome. Our surgeons participate in a multidisciplinary team approach to parathyroid disease that includes surgeons, endocrinologists and genetic counselors. In some cases, our surgeons may recommend genetic testing to determine if the parathyroid disease is inherited and ensure that family members get tested and treated early.