How are parathyroid adenomas treated?
The most common treatment is to remove the enlarged gland (or glands). This surgery cures the problem up to 98% of the time.
In patient who are too ill to have surgery, medication may be the only option. The different medications don’t reduce the extra amount of parathyroid hormone in the blood. Instead, they fight back by preventing the loss of calcium from bone. Hormone replacement therapy or other treatments for this condition must be taken for the rest of your life.
A prescription medication called cinacalcet (Sensipar®) reduces both calcium and parathyroid hormone levels in people with chronic kidney failure (secondary hyperparathyroidism). Its use in people with primary hyperparathyroidism is still being studied.
If I don't have symptoms, do I need surgery?
Surgery is the most common treatment for parathyroid adenoma, even for people who don't feel like they have any symptoms. For patients who have had high calcium levels for a number of years, it would be hard for them to tell if they are truly without symptoms.
Parathyroidectomy can make patients feel better, thus improving the overall quality of time. More importantly, parathyroidectomy can prevent osteoporosis and kidney stones.
If I decide to have surgery, what should I expect?
Several weeks before surgery, the surgeon will order tests to locate your one or more overactive parathyroid gland(s). These tests may include:
- An ultrasound of the neck.
- A scan that uses a drug called Tc-sestamibi.
If imaging can localize to one parathyroid gland, the surgeon will look for that particular gland first during surgery. However, all four parathyroid glands need to be identified during the procedure. This imaging is very important in terms of surgical planning. Even if no parathyroid gland showed up on imaging, the diagnosis is still there and the surgeon would still recommend surgery.
What happens during surgery to remove parathyroid nodules?
- A small incision is made in the front of the neck under general anesthesia.
- All 4 parathyroid glands are inspected during surgery. The surgeon takes out the abnormal parathyroid. If 1 or 2 abnormal parathyroid glands are found, they are removed and the remaining normal parathyroid gland can maintain normal calcium level.
- If all 4 parathyroid glands are abnormal, then 3½ of the glands are removed. Some parathyroid tissue needs to be left in the body to maintain normal calcium levels.
- Intraoperative parathyroid hormone levels are checked during surgery. If the diseased parathyroid gland(s) have all been removed, then the parathyroid hormone level before removal should drop at least 50% after removal.
Parathyroid glands removed during surgery will be checked by a pathologist (frozen evaluation) for confirmation that the parathyroid gland was indeed hyperactive.
Finding all four parathyroid glands during surgery will provide the highest cure rate in the long term.
What are the risks of having surgery?
All surgeries have risks. With parathyroid surgery, some patients experience:
- Short-term or permanent low calcium levels in the blood (hypocalcemia). These can manifest as numbness/tingling in the fingers and around the mouth and muscle cramps.
- Patients who have 3 or more parathyroid glands removed will definitely experience low calcium symptoms in the first week after surgery.
To reduce these risks:
- All patients will be on calcium and vitamin D supplements for the first 2 weeks after surgery. A patient who had 3½ glands removed may be instructed to take even more calcium pills.