The surgical removal of one or more parathyroid glands.

Used to remove primary tumors or hyperplasia of the glands, especially when they produce excessive parathyroid hormone.

The location of the parathyroid glands is generally behind the thyroid.

The location of an enlarged gland can be confirmed by a sestamibi scan or on ultrasound.

For secondary hyperparathyroidism improves bone and joint pain, decreases serum phosphorus, decreases serum calcium levels within the first week after surgery.

Following surgery a diet high in calcium, and phosphorus and supplemented with vitamin D are needed to avoid tetany and impaired bone mineralizaton.

Hypocalcemia seen after surgery related to number of osteoclasts present prior to surgery.

After removal of parathyroid for secondary hyperparathyroidism the rapid fall in parathyroid hormone levels is associated with suppression of bone resorption and increased bone formation.

Preoperative imaging can identify the location of parathyroid adenoma and minimize surgical incisions, dissection and risk of injury.

The operation can proceed under general anesthetic or a local anesthetic.

Preoperative testing using sestamibi scanning can help identify the location of glands, and can be used to limit the extent of surgical exploration when used in conjunction with intraoperative PTH hormone monitoring.

The underlying disease process determines how many of the parathyroid glands are removed, as some parathyroid tissue must be left in place to help prevent hypoparathyroidism.

Following surgical removal of an adenoma an immunochemiluminescent assay is used to determine whether the patient’s parathormone level has decreased: The half life of PTH, is 3 minutes, and a decreased level by 5 minutes confirmed by a 10 minute level verifies that the gland that was causing the hyperparathyroidism has been removed.

The PTH level is back to normal within 10–15 minutes.

The remaining parathyroid glands may take hours to several weeks to return to their normal functioning levels.

Following parathyroidectomy only 3% of patients with an adenoma experience a recurrence of a parathyroid tumor.

After parathyroidectomy for primary hyperparathyroidism disease 15% of patients show improvement in bone density 2-5 years after the procedure.

Patients must be placed on calcium supplements to prevent hypocalcemia and to restore lost bone mass.

After parathyroidectomy patients have improved functional performance suggesting that elevated PTH levels affect circadian rhythms and disrupt stage IV sleep, impair verbal memory, learning and attention span.

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