Where are the parathyroids?

The 4 parathyroid glands are the size of a rice grain each and they sit behind the butterfly shaped thyroid gland in the neck. While there are usually 4 parathyroid glands, the exact number can occasionally vary, as can their exact locations. They secrete a hormone called parathyroid hormone (PTH), which acts on many organs including the gut, bones, and kidneys to increase the blood level of calcium. If you have been referred for consideration for parathyroid surgery by your doctor, it may be because they have found a high calcium or PTH level in your blood.

When is parathyroid surgery recommended?

Removal of one or more of your parathyroid glands may be required for the following reasons:

• Weakening of your bones due to osteopenia or osteoporosis

• Kidney stones

• Kidney failure

• Very high blood calcium level

• Tiredness, fatigue and forgetfulness thought to be due to a high PTH level

• To prevent the complications of untreated hypercalcaemia in a healthy asymptomatic patient

Minimally invasive parathyroid surgery

When pre-operative imaging clearly identifies an abnormal parathyroid gland, surgery may be performed through a smaller, focused incision. This approach allows the affected gland to be removed while limiting unnecessary exploration of the neck. Not every patient is suitable for minimally invasive surgery, and the recommended approach depends on the diagnosis, imaging and likelihood of more than one abnormal gland.

Non-localising and complex parathyroid disease

Parathyroid imaging helps a surgeon plan an operation, but a scan that does not identify an abnormal gland does not necessarily rule out parathyroid disease or the need for surgery. Further imaging or a more extensive exploration of the neck may be recommended. Specialist experience is particularly important in multi-gland disease, renal hyperparathyroidism, inherited conditions and patients who have undergone previous neck surgery.

What is involved with parathyroid surgery?

For most patients, parathyroid surgery is performed as an “elective procedure”. This means that the date of the surgery is scheduled in advance, and you will be admitted to the hospital on the day of the surgery, having fasted for an appropriate amount of time. You will meet your anaesthetist on the day of the surgery, prior to the procedure.

The surgery is performed under general anaesthesia, with you fully asleep. The general anaesthetic is administered in the operating room, with your vital signs being monitored the entire time. The surgery usually takes 1 to 2 hours, occasionally longer, depending on the extent of the surgery and the condition being treated. You will wake up in the recovery room, with a small dressing over the incision on your neck. 

You will be moved to your ward bed approximately 1 hour after the completion of surgery, and you will be able to receive visitors at this time. You will be able to talk after surgery, and have something soft to eat once you are no longer drowsy.

Most patients are discharged the next morning. In some situations, a longer stay in hospital may be required for further observations, blood tests, or other reasons.

Recovery after parathyroid surgery

Most patients can eat, drink and walk soon after parathyroid surgery and are discharged on the same day or the following morning, depending on their circumstances. Temporary neck discomfort, swelling, voice changes or tingling around the lips and fingertips can occur. Calcium supplements and follow-up blood tests may be recommended while calcium and parathyroid hormone levels stabilise.

You will receive individual instructions about wound care, medications, activity and follow-up. Read our detailed After Surgery guide for further recovery information and advice about when to seek medical assistance.