Parathyroidectomy

The parathyroid glands are small glands, usually four in number, located behind the thyroid. They produce parathyroid hormone, which regulates the level of calcium in the blood. When one or more of them become overactive, this is called hyperparathyroidism: blood calcium rises, which can weaken the bones, promote kidney stones and cause tiredness, thirst, mood changes or difficulty concentrating. In most cases, only one gland is responsible: this is an adenoma, a benign tumour. Less often, several glands are enlarged (hyperplasia), particularly in kidney failure or inherited forms. When the diseased gland has been located before surgery (by neck ultrasound and a scintigraphy scan or other imaging), the surgeon can remove it through a small targeted incision: this is minimally invasive surgery. If its location is uncertain or several glands are involved, all four glands are explored through a horizontal incision at the base of the neck. Measuring parathyroid hormone during or after the operation helps confirm that the responsible gland has been removed. Surgery is the only treatment that cures hyperparathyroidism. At Clinique Pasteur Tunis, it is performed in close liaison with the endocrinologist, who confirms the indication and follows up calcium levels.