Parathyroidectomy - NYSORA

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Parathyroidectomy

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

parathyroidectomy, management, preoperative, intraoperative, postoperative, ECG, hypercalcemia, hydration, loop diuretics, bisphosphonates, cinacalcet, renal replacement therapy, thyroidectomy, reinforced endotracheal tube, balanced anesthesia, urinary catheter, arterial cannula, calcium, central venous catheter, parathyroid hormone, PTH, temperature, warming blanket, IV fluids, careful positioning, neck extension, head-up, oral analgesics, phosphate, magnesium, calcium gluconate, calcium chloride, hypocalcemia

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.

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