Surgical Removal of Parathyroid Glands

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Duke endocrine surgeons perform parathyroid surgery to remove abnormal parathyroid glands or tissue. The glands are located behind the thyroid gland in the neck. Parathyroidectomy may be recommended as treatment when hyperparathyroidism or parathyroid cancer is present.

Whenever possible, the surgeons use small incisions to reach your parathyroid glands. This minimally invasive approach shortens your recovery time, reduces your post-surgical pain, minimizes scarring and results in fewer side effects when compared to parathyroid surgery that is performed through larger incisions. 

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What is a Parathyroidectomy?

A parathyroidectomy is the surgical removal of an overactive parathyroid gland or a growth on the gland. The procedure has a 95% cure rate for primary hyperparathyroidism. It allows your body to produce normal levels of parathyroid hormone and calcium. Left untreated, hyperparathyroidism can result in kidney problems, changes to your nervous system, digestive system, joint paint and osteoporosis.  

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Surgical Consultation

Once a diagnosis of primary hyperparathyroidism has been secured, a surgical consultation can determine if you need surgery or can be safely monitored without surgery. If surgery is indicated, preoperative imaging of the overactive parathyroid gland(s) can indicate if you are a candidate for minimally invasive parathyroidectomy.  

Sestamibi-SPECT Scan

A mild radioactive dye (called sestamibi) is injected into the vein and absorbed by the overactive parathyroid gland. Rotating X ray scans identify the presence and location of the sestamibi. This test does require injection of the dye and multiple X rays, and can sometimes be more time consuming. 

4-D CT Scan

The “4-D” refers to the fourth dimension – which is very precise timing of the intravenous contrast and the scanning. This test is very accurate and finds parathyroid glands that may hide in uncommon areas such as high in the neck, behind the great vessels, such as the carotid, behind the esophagus, or in the chest.  This test requires expertise in performing the scan properly, and interpreting it well. It requires intravenous contrast and does have radiation exposure. 

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Parathyroidectomy Treatments

Minimally Invasive Approach
When possible, Duke endocrine surgeons use small incisions to perform a parathyroidectomy. Most people experience less pain and fewer complications related to anesthesia, such as vomiting, nausea, and sore throat. The smaller incisions also minimize scarring, which leaves a more cosmetically pleasing result.

Conventional Parathyroidectomy 
Not every patient with parathyroid disease is a candidate for minimally invasive surgery. There are times when a large neck incision is necessary so the surgeon can view all four parathyroid glands and best identify the gland to be removed. 

Sometimes Complex Surgery Is Necessary
If you suffer from multiple overactive glands, more complex surgery may be needed. If you have permanent hypoparathyroidism, one option is a procedure to remove tissue for preservation and use at a later date. This process is cryopreservation of your parathyroid tissue. If you have parathyroid cancer, surgery may also include the removal of lymph nodes, thyroid tissue, muscles, and nerves from the neck or the affected area, depending on the extent of the disease.

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When it comes to your care, you want the very best. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our diabetes and endocrinology program is rated as high performing among the nation's top hospitals, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.

Why Choose Duke

Less Pain, Excellent Long-Term Cure Rates
Our patients experience fast recovery times, less pain, return to work/life quickly and have minimal chance of experiencing significant side effects such as hoarseness or low calcium levels. Research shows that patients who undergo minimally invasive parathyroid surgery experience excellent long-term cure rates which are comparable to patients who undergo traditional, more invasive parathyroid surgery. 

Sophisticated Pre-Operative Imaging
We use 4-D Computed Tomography (CT) imaging -- available at only a handful of centers in the country -- to locate hard-to-find parathyroid glands before surgery. 
For the rare occasions where parathyroid glands are located in hard-to-reach areas such as  the chest, we work closely with thoracic surgeons using minimal access techniques to remove these glands safely. 

Surgical Success Confirmed in the OR
Our surgeons use a 10-minute hormone test during surgery to confirm the success of the operation. Surgeons may also use a gamma probe to detect low-level radioactive tracers that accumulate in overactive parathyroid glands. The probe detects the tracer and confirms whether the surgeon has removed the affected area.

This page was medically reviewed on 02/12/2020