Parathyroid Surgery

The parathyroid glands are small organs that fit more or less tightly to the thyroid gland and regulate the body's calcium metabolism. The regulation takes place via the hormone of the parathyroid gland, the so-called parathyroid hormone.

Surgery of the parathyroid glands is usually necessary if there is an overproduction of the parathyroid hormone. If this overproduction is caused by enlargement of the parathyroid glands for reasons that are not obvious, the resulting disease is called primary hyperparathyroidism. In this case, either only one gland (about 80 percent) or two glands (about two percent) or all four glands (17 percent) may be affected. The disease is almost always benign, in rare cases there is an inherited disorder. Depending on the number of diseased glands, different surgical procedures are chosen.

It is important to leave enough healthy parathyroid tissue to ensure that calcium metabolism continues to function and to remove all diseased tissue. The possible positional variations of the parathyroid glands and the recognition of diseased tissue require a very experienced surgeon, especially for this type of surgery. At Martha-Maria Hospital Munich, this experience is given to a high degree by the large number of operations we perform.

In addition to the experience, some special devices are indispensable in parathyroid surgery, for example the possibility of cold preservation of parathyroid tissue. This tissue can be preserved for years and, if necessary, after thawing, can be implanted into the human musculature to resume normal function.

A further newer procedure in parathyroid surgery, which we have also been using since 1998, is the measurement of parathyroid hormone during surgery, the so-called Quick Parathyroid Hormone Test. This parathormone measurement can be used to measure the success of the operation at an early stage during the operation.

If the appropriate conditions are met, minimally invasive parathyroid operations are also possible.

If the overproduction of parathyroid hormone is due to reactive reasons (such as chronic kidney failure or if calcium cannot be absorbed into the body through the intestine), we speak of reactive hyperparathyroidism. In this case all four parathyroid glands are always diseased and enlarged. They are either removed except for a small, normal-sized residue (subtotal parathyroidectomy) or all parathyroid glands in the neck area are removed and part of the tissue is implanted into the muscles of the forearm in the same session (total parathyroidectomy plus autologous transplantation). During these operations, cryopreservation of the parathyroid tissue is then of great importance to the patient.

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