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Parathyroid Surgery

The parathyroid gland is not one but four glands that are sited next to the thyroid gland, hence it’s name para(next to)thyroid glands. However, other than the anatomical relationship of the glands, the thyroid and parathyroid glands have nothing else in common. The parathyroid glands produce a small size protein called parathyroid hormone(PTH).

PTH is responsible for maintaining the calcium balance in the bloodstream. If there is insufficient PTH, the calcium will drop and if it’s too much, the calcium levels will rise.

When the parathyroid gland enlarged, it is usually due to a single gland enlargement, called a parathyroid adenoma( and very rarely parathyroid carcinoma/cancer). When there is prolonged renal failure, all the 4 glands can secondarily enlarged due to low blood calcium. The latter is called parathyroid hyperplasia. The result of an enlarged parathyroid gland is the over production of parathyroid hormone. A high level of PTH results in mobilization of the calcium from its storage (usually the bone) into the bloodstream, and is filtered by the kidneys. High calcium also affects the stomach lining and mental status.

The patient with abnormally high calcium in patients present with renal stones, gastric ulcers, fractures or even depression.

The diagnosis is usually found first due to a high calcium level and localized with the help of a parathyroid scan. The sestamibi tehnicium subtraction scan is only add aid but does not replace the surgical skill needed to localize the diseased parathyroid gland.

The treatment is surgical removal of the abnormal parathyroid if it’s one lesion or all of the 4 enlargement in hyperplasia. The treatment results depends on the difficulty of locating the parathyroid, hence it depends on surgical expertise of the surgeon.

The highest risk involved with parathyroid surgery is not being able to localize the abnormal parathyroid gland or glands. The voice can be at risk since the recurrent laryngeal nerves run next to the parathyroid glands. Distinguishing a benign parathyroid adenoma and a malignant parathyroid cancer can be difficult and can pose a challenge during intraoperatively test ( called a frozen section )

In the immediate post surgery period, the patient may experience cramps due to a sudden drop in the calcium level. Thus, calcium replacement and vitamin D may be needed for such patients.

The final arbiter of successful parathyroid surgery is to see that normalization of the calcium and parathyroid control mechanism.

Parathyroid Surgery Singapore

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