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Dr. Andrew Rynne

Family Physician

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Do glands need to be removed if one is diagnosed with parathyroid disease?

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Dr. Shehzad Topiwala

Endocrinologist

Practicing since :2001

Answered : 1663 Questions

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Posted on Wed, 13 Jun 2018 in Thyroid Problem and Hormonal Problems
Question: I had a parathyroidectomy, of one parathyroid gland, in 2014.
I now have parathyroid disease again.
Is it suggested that the remaining three glands be removed at this time?
Do I run the risk of having 2 more surgical procedures if I only have one parathyroid gland removed again.
doctor
Answered by Dr. Shehzad Topiwala 51 minutes later
Brief Answer:
Parathyroid

Detailed Answer:
The answer to this depends on how many of the remaining 3 parathyroid glands are over-active. If diagnostic testing before surgery is able to indicate whether only 1 or 2 or all 3 parathyroid glands are secreting excessive parathyroid hormone and causing high blood calcium levels, then it a consultation with an endocrinologist and an endocrine surgeon is warranted.
The medical and surgical team will jointly try to determine the best course of action for you.
Typically it is only one parathyroid gland that causes problems. Sometimes 2 are over-active, and uncommonly all 4 are overactive.
Occasionally it is hard to ascertain this before surgery as to which ones are the trouble-makers. So in these instances, the surgeon examines the physical characteristics of each of the parathyroid glands in the neck while operating. Additionally (s)he typically will remove one parathyroid gland at a time and quickly check blood levels of parathyroid hormone (while the patient is still on the operating table , under anaesthesia). If the levels drop by a certain percentage, then (s)he gets a fair idea that the culprit gland is out and surgery may be terminated. If the blood levels of parathyroid hormone still do not fall sufficiently despite removal of one gland the surgeon first reconfirms whether what (s)he removed was indeed parathyroid plus if it was removed fully. Then after confirming if the parathyroid hormone levels are still high then other parathyroid glands are approached in the same way.
This is a complex issue best left to the discretion and judgement and expertise of your healthcare team.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Shehzad Topiwala 12 minutes later
Thank you for your answer. I do have an appointment with a very good head and neck surgeon at Celebration Hospital outside of XXXXXXX
I want to have some idea of what I should be hearing from my endocrinologist as well as the surgeon.
doctor
Answered by Dr. Shehzad Topiwala 24 hours later
Brief Answer:
Follow up

Detailed Answer:
Yes an endocrinologist and endocrine surgeon are best suited to guide you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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