Parathyroid surgery is introduced here. The standard 'big' parathyroid operation is out of date and requires the surgeon to "explore" most of your neck to find and examine all four parathyroid glands. Most patients don't need this large operation!

Surgery is the only way to treat parathyroid disease...There are no medications or pills that work to cure parathyroid disease. The parathyroid tumor must be removed by a surgeon. As soon as the parathyroid tumor has been removed, you are cured!  It is very likely this will change your life. If you have hyperparathyroidism you need to have parathyroid surgery. BUT IT IS EASY if you have an expert surgeon!

Note: We performed a MIRP mini parathyroid operation live on the Internet for you to watch.
Click Here to watch a movie of this operation as it occurred live (no editing).

Since 1925, the standard treatment for parathyroid disease (primary hyperparathyroidism) has been to surgically remove the parathyroid gland (or glands) which are overproducing parathyroid hormone. Remember, this is a hormone problem, so the goal is to remove the source of the excess parathyroid hormone (remove the bad parathyroid gland, leave the normal parathyroid glands). Again, the concept is really quite simple: Find which parathyroid gland has become a tumor and is making too much parathyroid hormone and take it out...leaving the other normal parathyroids alone. The normal parathyroid glands will take over and you will be cured. You don't need all four parathyroid glands.

The 'standard parathyroid operation' has not changed since its invention in 1925, and is performed by putting the patient to sleep under general anesthesia. An incision is made in the neck, the muscles of the neck are retracted sideways and the thyroid gland is loosened up and moved aside to allow the surgeon to identify the four parathyroid glands which reside moderately deep in the neck behind the thyroid. Patients having a 'standard parathyroid operation' are always hospitalized over night, and sometimes as long as a two or even three days. The incision for the standard parathyroid operation has to be made of sufficient length to allow the surgeon adequate exposure of the numerous important structures within both sides of the neck, and thus it is typically six or seven (and even up to 10) inches long. These wounds eventually heal nicely but you will have a big scar on your neck forever. The picture on the left shows the incision needed to expose the parathyroid glands on both sides of the neck when doing the old-fashioned parathyroid surgery. This is the operation that your doctor may be reluctant to send you for--often for good reason. The editor of this site believes this operation should never be done in this fashion, however, this is the operation you will probably get if you don't go to a parathyroid specialist. This operation is a very out-dated. There is better technology available. You can do better. Keep reading.

Because of the numerous small nerves and other important structures within the neck which reside around the parathyroid glands, the 'standard' parathyroid operation can be technically challenging and has the best results when performed by experienced endocrine (parathyroid) surgeons or surgeons with extensive head and neck operative experience. Numerous publications in medical journals have shown that the success rate following parathyroid surgery is directly related to the number of parathyroid operations the surgeon has performed (we have a page devoted to cure rates). This is what you will find when you read about parathyroid surgery in every text book, or on any web site on the Internet...the experience of the surgeon is more important than anything else.  The cure rate for a standard parathyroid operation performed by a general surgeon is about 85 to 90% when performed through the big incision you see above and at the bottom of this page. Endocrine surgeons have a cure rate between 93 and 97%. On other pages you will see that newer forms of mini parathyroid surgery have cure rates of 99% or better in most patients.

During the standard operation, the surgeon must identify all four parathyroid glands and remove whichever one(s) is enlarged. As covered in the section describing hyperparathyroidism in detail, the vast majority of time there is just one large parathyroid gland (an adenoma which is a benign parathyroid tumor) and three normal parathyroid glands. In this situation the one large gland (the parathyroid adenoma) would be removed leaving the three normal parathyroid glands to function in a normal fashion indefinitely. If the surgeon found all four parathyroid glands to be enlarged (found in only 2-3% of patients and called "parathyroid hyperplasia"), he/she would typically take out 3 or 3-1/2 of these glands leaving some parathyroid tissue behind to function normally in the future. In experienced hands (endocrine surgeons who have done over 250 of these operations), this big old-fashioned operation has a cure rate of about 94-95 percent, but can be as low as 85% for surgeons who operate on parathyroid patients infrequently. You MUST pick your surgeon wisely.

To complete a 'standard parathyroid operation' safely with a high rate of success, the operation occurs on both sides of the neck (a standard bilateral neck exploration), and is always performed using general endotracheal anesthesia. Because of the concern over general anesthesia in some elderly patients, and concerns about a 8 inch (or larger) incision on the neck, and the risks of damage to the nerves to the voice box, some endocrinologists and family doctors elect not to send patients for this operation until the patients develop SEVERE hyper-parathyroid symptoms or have a significant loss of bone density (osteoporosis). This means of management of parathyroid disease may or may not be in the best interests of the patient based upon the potential risks (small, but real) of the standard parathyroid operation. You need to discuss the pros and cons of routine parathyroid surgery with your endocrinologist and weigh the risks of surgery versus continued monitoring of your body calcium stores and your bone density. NOTE: Minimal parathyroid surgery is dramatically changing the way endocrinologists treat parathyroid disease, sending almost all of their patients for surgery. Read a recent survey of endocrinologists (Click Here) to see how 98% of them would have a minimally invasive parathyroid operation instead of a standard parathyroid operation. The picture on the right shows how small of an incision is made for a MIRP minimally invasive parathyroid operation- it is a 1-inch incision (or less!) and usually takes less than 20 minutes to perform. Again, if you can have a 20 minute out-patient procedure to CURE your parathyroid problem, then it almost always makes sense to get this done instead of waiting to develop kidney stones, osteoporosis, or severe symptoms. Thus, you need to read more on this web site about your surgery options and the difference between the old-fashioned operation and mini-parathyroid surgery. When we do this operation, it typically takes less than 19 minutes and has a cure rate near 100%. Patients go home within a couple hours.  Keep reading...

This big-old-fashioned parathyroid operation typically takes 2 to 6 hours to complete (depending on the case and the skill of the surgeon), and 5 to 15 percent of patients will not be cured after the operation. As many as 4 percent will have a serious complication depending on your surgeon's experience. You can expect to spend 1 to 3 nights in the hospital. This is the way they did it in 1925. FOR ALMOST ALL PATIENTS--THIS IS NOT THE WAY IT SHOULD BE DONE ANYMORE. THERE ARE NEW AND BETTER WAYS TO DO THIS OPERATION!  If your surgeon discusses having surgery this way, and "exploring" for your parathyroid glands, you may want to find an expert surgeon (endocrine surgeon) who performs parathyroid surgery on a more frequent basis. However, parathyroid disease is an uncommon problem, so almost all surgeons only know how to do parathyroid surgery the old-fashioned way--the way they saw it done years ago when they were learning. Tell your endocrinologist and/or your family doctor that you want a surgeon that is an expert in parathyroid surgery and that you do not want the same general surgeon that they send their gallbladder and breast biopsy surgery patients to. Ask for an endocrine surgeon.

Parathyroid.com EDITOR'S NOTE:   The standard operation for parathyroid disease as discussed on this page can be avoided for all patients with primary hyperparathyroidism if they have a surgeon who is an expert in parathyroid surgery. The old fashioned parathyroid operation is a safe and effective operation, but typically is a MUCH larger and more complex operation than is needed.  Since the invention of Minimally Invasive Parathyroid surgery in the early and mid 1990's, it has been documented that minimal parathyroid surgery has a cure rate that is higher, a complication rate that is about 1/4 or less, and it can be done with local anesthesia or "twilight anesthesia" typically in less than 20 minutes. VIRTUALLY ALL parathyroid patients can have a MIRP mini-parathyroid operation at some centers performed by some surgeons. NOTE: Even the standard operation should not be done in the old fashioned way...there are new techniques used by the best parathyroid surgeons that make this operation smaller and more successful (measuring hormone levels during the operation, etc). There are several pages on minimal parathyroid surgery on this web site, including surveys from endocrinologists and summaries of journal articles showing statistical evidence of the benefit of minimal parathyroid surgery. Before you have surgery, make sure you understand your options! 

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