Learning objectives

• Define parathyroidectomy
• Describe the complications that are associated with parathyroidectomy
• Management of a patient undergoing a parathyroidectomy

Definition and classification

• Parathyroidectomy is the surgical removal of one or more of the four parathyroid glands
• The surgery is performed to remove an adenoma or hyperplasia of the parathyroid glands and treat excessive parathyroid hormone (PTH) production (i.e., hyperparathyroidism) and associated hypercalcemia

Indications

• Primary hyperparathyroidism: Hyperfunction of the parathyroid glands (i.e., adenoma, carcinoma, or hyperplasia) leading to an overproduction of PTH 
• Secondary hyperparathyroidism: Appropriate compensatory response of the parathyroid glands to secrete more PTH in response to a condition (i.e., chronic kidney disease, vitamin D deficiency) that produces hypocalcemia
• Tertiary hyperparathyroidism: Long-standing secondary hyperparathyroidism starts to behave like primary hyperparathyroidism, usually associated with advanced kidney failure
• Ectopic hyperparathyroidism: Secretion of PTH by tissues other than the parathyroid glands

Patient characteristics

• Skeletal muscle weakness, myopathy
• Nephrolithiasis, polyuria, polydipsia, renal failure
• Anemia
• Peptic ulcer disease, vomiting, pancreatitis
• Hypertension, prolonged PR interval, short QT interval
• Generalized osteopenia, bone pain, pathological fractures
• A decline in mental function, personality changes, lethargy, mood disturbances

Complications

• Hypoparathyroidism and associated hypocalcemia
• Recurrent laryngeal nerve damage
• Hematoma
• Infection
• Edema of the glottis and pharynx

Management

See also thyroidectomy considerations

Suggested reading

• Pollard BJ, Kitchen G. Handbook of Clinical Anaesthesia. 4th ed. Taylor & Francis group; 2018. Chapter 20 Head and neck surgery, Macnab R and Bexon K.
• Malhotra S, Sodhi V. Anaesthesia for thyroid and parathyroid surgery. Continuing Education in Anaesthesia Critical Care & Pain. 2007;7(2):55-58.