Parathyroidectomy

Overview

A parathyroidectomy is a surgery to remove one or more of the parathyroid glands. These are four tiny glands in your neck that help control the amount of calcium in your blood. This surgery is most often done when one or more of these glands makes too much parathyroid hormone (hyperparathyroidism), causing high calcium levels that can lead to health problems.

Parathyroidectomy is a fairly common surgery. Hyperparathyroidism is the third most common endocrine disorder (after diabetes and thyroid disease), and surgery is the only cure for many cases.

It mainly affects adults over 50, especially women. It can also occur in people with certain genetic conditions, kidney disease, or those who have had radiation to the neck.

Symptoms

Common symptoms

• Bone and joint pain
• Frequent kidney stones
• Fatigue and weakness
• Depression or trouble concentrating
• Unexplained nausea, vomiting, or loss of appetite
• Frequent urination and thirst

Symptoms in children

• Poor growth and bone deformities
• Muscle weakness and cramps
• Irritability or developmental delays
• Vomiting, constipation, or dehydration

Symptoms in older adults

• Confusion or memory problems that may look like dementia
• Muscle weakness leading to falls
• Fragile bones and fractures
• Depression and fatigue

Causes

Main causes

• A noncancerous growth (adenoma) on one or more parathyroid glands – this is the most common cause.
• Enlargement (hyperplasia) of all four parathyroid glands.
• Rarely, a cancerous tumor of a parathyroid gland.

Risk factors

• Being female
• Age over 50
• Long-term low calcium or vitamin D deficiency
• A family history of hyperparathyroidism
• Certain genetic disorders (like MEN1 or MEN2)
• Long-term use of lithium (a mood stabilizer)
• Radiation exposure to the neck

When to see a doctor

See a doctor urgently if:

• If you have severe bone pain or a broken bone after a minor injury
• If you have symptoms of a kidney stone (severe side/back pain, blood in urine)
• If you notice sudden confusion or extreme fatigue

Book a routine appointment if:

• If you have ongoing tiredness, muscle aches, or mood changes that don't go away
• If you have unexplained nausea, constipation, or frequent urination
• If routine blood tests show high calcium levels

Diagnosis

Your doctor will review your symptoms, family history, and order blood tests. If calcium and parathyroid hormone levels are high, imaging tests help find the overactive gland(s). A diagnosis is confirmed by blood tests and often a special scan.

Tests that may be done

• Blood tests for calcium, parathyroid hormone (PTH), and vitamin D
• 24-hour urine test to check calcium excretion and rule out other causes
• Sestamibi scan – a nuclear medicine scan that lights up overactive parathyroid glands
• Ultrasound of the neck to see the glands
• CT or MRI scans if needed for precise location

What to expect at your appointment

Your doctor will explain each test and why it's done. A sestamibi scan involves a small injection of a radioactive tracer. It is safe and the radiation is very low. You may need to stop taking calcium or vitamin D supplements before some tests. Results usually come back within a few days to a week.

Treatment

The only cure for primary hyperparathyroidism is surgery to remove the overactive gland(s). In some cases, if symptoms are mild or surgery is not possible, your doctor may recommend monitoring or medications to lower calcium. Surgery is very effective and safe.

Self-care at home

• Stay hydrated – drink plenty of water to help prevent kidney stones.
• Avoid taking extra calcium or vitamin D supplements unless your doctor says it's safe.
• Get moderate exercise to maintain bone strength, but avoid high-impact activities if bones are fragile.
• If you have very high calcium, avoid antacids that contain calcium.

Medical treatments

If surgery is not an option, your doctor may suggest medications that help lower calcium or treat symptoms. These can include drugs that block the effect of parathyroid hormone, or medications to protect your bones. No specific brand or dose is mentioned here – your doctor will choose the best one for you.

When is surgery considered?

Surgery is usually recommended when calcium levels are very high, if you have symptoms like kidney stones or bone pain, or if your bones are weakening. It is also advised for younger patients and those with a family history. The surgeon removes the enlarged gland(s) – often through a small incision in the neck, with a high success rate and quick recovery.

Living with this condition

After a successful parathyroidectomy, most people feel much better within a few weeks. Energy levels improve, bone pain lessens, and mood often lifts. You may need to have regular blood tests to check calcium and PTH levels. Most people can resume normal activities within a week or two.

Lifestyle tips

• Stay physically active to keep bones and muscles strong.
• Drink enough water every day to protect your kidneys.
• Eat a balanced diet rich in vegetables, fruits, and whole grains.
• Avoid smoking and limit alcohol – both can weaken bones.
• Get enough sunshine or take vitamin D supplements as advised by your doctor.

Diet and exercise

After surgery, you may need to temporarily increase your calcium intake if your doctor advises it. Gentle walking, stretching, and strength training are good. Avoid heavy lifting or contact sports until your doctor says it's safe. If you had bone loss, weight-bearing exercises like walking are especially helpful.

Mental health and emotional wellbeing

Dealing with high calcium and surgery can be stressful. Some people feel anxious or down before or after the procedure. It's common to feel emotional as your body adjusts. Talk to your doctor if you feel overwhelmed – they can connect you with support.

Prevention

Most cases of hyperparathyroidism cannot be prevented because they are caused by a growth or genetic condition. But you can reduce your risk of complications by staying hydrated, getting enough vitamin D, and not taking high-dose calcium supplements without medical advice.

Screening programmes

Routine screening for high calcium is not recommended for everyone. However, if you have a family history of hyperparathyroidism or related genetic conditions, your doctor may suggest regular blood tests.

Complications

If left untreated

• Osteoporosis – weakened bones that break easily
• Kidney stones and kidney damage
• High blood pressure and heart rhythm problems
• Cognitive issues – memory loss, confusion, depression
• Rarely, a dangerous condition called hypercalcemic crisis with very high calcium

Long-term outlook

The outlook after parathyroidectomy is excellent. Over 95% of people are cured and their calcium levels return to normal. Symptoms like bone pain, fatigue, and mood problems usually improve dramatically. With proper management, most people live full, healthy lives without long-term problems. Even if you are not a candidate for surgery, medications and monitoring can keep you well.

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