What Is Parathyroid Surgery?

Start with a puzzle. Behind your thyroid, in the front of your neck, sit four glands each about the size of a grain of rice. Most people never hear their names — the parathyroids — until a routine blood test comes back with a calcium level that's too high. So why would glands that small ever need an operation? This walkthrough answers that question, one part at a time.

First, what do the parathyroid glands actually do?

They're calcium managers. The parathyroids release parathyroid hormone (PTH), which keeps the calcium in your blood within a narrow range — drawing on the bones, the kidneys, and the gut to nudge the level up or down as needed. Despite the similar name and shared neighbourhood, they're separate from the thyroid gland and do a completely different job; our article on thyroidectomy covers surgery on the thyroid itself, which helps show where one gland's territory ends and the other's begins.

So what goes wrong, and why is surgery offered?

In the most common pattern, called primary hyperparathyroidism, one of the four glands becomes enlarged and overactive — often because of a benign growth in that gland — and starts releasing more PTH than the body needs. Calcium creeps up and stays up. Some people feel nothing at all and the problem is spotted only on blood work; others notice tiredness, thirst, passing urine more often, aches, or kidney stones over time, and bones can gradually lose strength if high calcium is left running for years.

Because the fault sits in the gland itself, removing the overactive gland — an operation called a parathyroidectomy — is the treatment that addresses the cause directly. That's the point the short video at the top of this page makes: "Parathyroid Surgery", running about three and a quarter minutes, walks through parathyroid disease and why an operation to remove the affected gland is offered for it. Whether surgery is right for you, and how urgently, depends on your calcium level, your symptoms, your bone and kidney health, and your own team's assessment — some people with mild findings are monitored instead, at least for a while.

How do surgeons know which gland to remove?

That's the planning question, and it's answered before anyone picks up a scalpel. Blood tests confirm the pattern — calcium and PTH together — and imaging is then used to try to locate the overactive gland ahead of time. Neck ultrasound and a specialised scan called a sestamibi scan are the commonly used tools. If one gland lights up clearly, the operation can be focused on that gland alone, sometimes through a smaller incision — the approach shown in this site's second video, "Minimally Invasive Parathyroid Surgery". If imaging doesn't pin the problem down, the surgeon plans a neck exploration in which all four glands are checked and the abnormal one — or ones — removed.

What happens during the operation itself?

You'll be asleep under a general anaesthetic. The surgeon makes a small incision in the front of the neck, usually placed in a natural skin crease, works past the thyroid to reach the parathyroid glands behind it, and removes the overactive gland while protecting the nearby structures — particularly the nerves that serve the voice box, which is why voice changes are on the consent list even though they're uncommon. In some operations the team measures PTH during surgery itself, because the hormone level falls quickly once the overactive gland is out, giving an early sign the right gland has been found. The removed tissue is then sent for laboratory examination, as removed tissue routinely is.

And afterwards — what does recovery look like?

Most people are surprised by how ordinary it feels: a sore or stiff neck and a scratchy throat for a few days are the usual complaints, rather than severe pain. Calcium is checked with blood tests after surgery, because once the overactive gland is gone the level needs to settle — and occasionally it dips low for a while, which can cause tingling around the mouth or in the fingers and needs reporting to the team promptly. A hoarse or weaker voice can also happen temporarily while the area heals. You should be told who to contact if any of that appears, and you'll usually have a follow-up check of your calcium — and a conversation about your bones and kidneys, if they were part of the picture — once things have had time to settle.

So the short answer to the opening puzzle is this: parathyroid surgery isn't about the size of the glands, it's about what one misbehaving gland does to the calcium balance of your whole body. Take the misbehaving gland out, and the system it was overriding can usually get back to managing itself.

References & further reading

• MedlinePlus — Parathyroid Disease / Hyperparathyroidism: https://medlineplus.gov/parathyroiddisorders.html
• MedlinePlus Medical Encyclopedia — Parathyroidectomy: https://medlineplus.gov/ency/article/003280.htm
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) — Primary Hyperparathyroidism: https://www.niddk.nih.gov/health-information/endocrine-diseases/primary-hyperparathyroidism
• NHS — Hyperparathyroidism: https://www.nhs.uk/conditions/hyperparathyroidism/

Frequently Asked Questions

Is parathyroid surgery the same as thyroid surgery?

No. The glands share a neighbourhood in the neck and their names sound alike, which causes real confusion, but they're different organs with different jobs and different operations. A parathyroidectomy removes one or more parathyroid glands; a thyroidectomy removes some or all of the thyroid.

Does everyone with high calcium need this operation?

No. High calcium has several possible causes, and parathyroid surgery is only relevant when testing points to an overactive parathyroid gland. Even then, some mild cases are monitored with regular blood tests rather than operated on straight away — that's a decision for your own team, based on your results.

Will I have a scar?

There is a small scar in the front of the neck, because that's where the glands are reached from. Surgeons generally place the incision in a natural skin crease where possible, and for most people it fades to a thin line over time, though exact appearance varies from person to person.

What are the main risks I should know about?

As with any operation there are the general risks of anaesthesia, bleeding, and infection. Specific to this surgery, the calcium level can fall too low after the gland is removed — usually temporarily — and the nerves to the voice box can be bruised or damaged, causing a hoarse or weaker voice, which is usually temporary but can be lasting. Your surgeon will go through the risks that apply to your operation before you consent.

MedicalVideos.com has published trusted medical videos since 2007. The site was founded by Dr. Mohamed Ibrahim, MD, PhD — physician-scientist.

Educational only — this article is general information about parathyroid surgery, not medical advice and not a diagnosis. Whether this treatment, or any treatment, is right for you is a matter for your own care team, who know your results and your history.