A parathyroid adenoma is a benign tumor that forms in the parathyroid glands located in the neck region. These tumors are generally among the health issues that can be treated and have a good prognosis.
The parathyroid glands are four small glands located behind your neck, and adenomas that arise in these glands can be treated with surgery. Parathyroid surgery is usually performed through a small incision made on the front or side of the neck. This procedure is mostly performed under general anesthesia, and you may sometimes need to stay in the hospital for one night.
In this article, you will clearly learn what a parathyroid adenoma is, how it is diagnosed, and how the surgery is performed. You will also find all the details you need to know about the pre-operative preparation process and the post-operative recovery period.
What are the parathyroid glands and what is a parathyroid adenoma?
Located behind the thyroid gland, the parathyroid glands are vital organs that control your body's calcium balance. These small glands are only the size of a lentil (approximately 3-4 mm) and weigh an average of 30-60 mg.
The function of the parathyroid glands
The parathyroid glands produce a hormone called parathyroid hormone (PTH) that regulates calcium levels in the body. In fact, these glands act as a kind of "thermostat" for the calcium level in your body. When the calcium level drops, the parathyroid glands secrete PTH, allowing calcium to be released from the bones and helping more calcium to be absorbed from the kidneys.
Maintaining calcium balance is very important because this mineral plays a role in many vital functions such as proper muscle and nerve function, bone health, and heart rhythm. Furthermore, the parathyroid glands also help regulate phosphorus levels by increasing the excretion of phosphorus from the kidneys.
Normally, a person has 4 parathyroid glands - usually two on each side of the thyroid gland. However, sometimes people may have a higher number of parathyroid glands.
What does parathyroid adenoma mean?
A parathyroid adenoma is a benign tumor that forms in one (rarely more than one) of the parathyroid glands. This tumor causes an excessive amount of parathyroid hormone to be secreted into the blood. As a result, calcium levels in the blood rise, and this condition is called hyperparathyroidism.
The vast majority of hyperparathyroidism cases (more than 90%) are caused by an adenoma in a single parathyroid gland. Thus, various health problems can arise due to the rise in blood calcium levels.
Is a parathyroid adenoma cancer?
A parathyroid adenoma is definitely not cancer. Although the word tumor usually brings cancer to mind, a parathyroid adenoma is a completely benign formation. Being benign means that it does not spread to other parts of the body and does not grow outside its own capsule.
Parathyroid cancer, on the other hand, is an extremely rare condition. It is seen in approximately 1 in 1,000 patients with parathyroid disease. Only a few dozen cases are detected annually in the United States, and therefore many doctors may never see a case of parathyroid cancer throughout their careers.
Both parathyroid adenoma and parathyroid cancer produce excessive amounts of PTH, but in cancer, PTH levels are much higher and symptoms may be more severe. Therefore, it is important to consult a specialist doctor if high PTH and calcium values are detected.
Causes and symptoms of parathyroid adenoma
Parathyroid adenoma, a benign tumor originating from the parathyroid glands, is an insidious health problem that affects calcium metabolism. Despite their small size, these tumors can disrupt our body's calcium balance and lead to various symptoms.
What causes parathyroid adenoma?
Although the exact cause of parathyroid adenoma is unknown, some factors are thought to play a role in its formation. In a small portion of patients, it has been observed that a familial or hereditary condition is involved. Additionally, exposure of the head and neck region to radiation during childhood may increase the risk of developing a parathyroid adenoma.
Long-term low-calcium nutrition is also cited among the possible causes of adenoma. It is thought that the small amount of calcium in the body resulting from malnutrition forces the parathyroid glands to work harder, eventually leading to an adenoma.
What is hyperparathyroidism?
The most important problem caused by parathyroid adenoma is a condition called hyperparathyroidism. This is the excessive secretion of parathyroid hormone (PTH) into the blood as a result of the overactivity of the parathyroid glands.
The most common cause (85%) of primary hyperparathyroidism is the enlargement of one of the parathyroid glands, and this condition is called parathyroid adenoma. As a result, the blood calcium level rises and calcium loss from the bones begins. Excessive PTH causes too much calcium to be released from the bones into the blood, leading to hypercalcemia (high calcium).
If treatment is delayed, parathyroid adenoma can cause stone formation in the urinary tract and bone fractures. In some cases, calcium levels can rise to life-threatening levels.
Fatigue, bone pain, and other symptoms
The symptoms of parathyroid adenoma progress insidiously and are difficult to notice at first. Prof. Dr. Erhan Ayşan states, "Parathyroid adenoma is an insidious disease that may go unnoticed for years, but can be diagnosed even with a simple blood test."
The most common symptoms are:
Weakness and fatigue
Widespread bone and joint pain
Muscle weakness and cramps
Kidney stones
Heartburn and acid reflux
Nausea and vomiting
Abdominal pain and cramps
Loss of appetite
Depression and memory problems
Besides these, excessive thirst, frequent urination, high blood pressure (in about 50% of patients), itching, and heart rhythm disturbances may also be seen.
The severity of the symptoms is directly proportional to the calcium level in the blood. Because the symptoms of parathyroid adenoma can be confused with many diseases, its diagnosis is often delayed. In patients who have weakness, fatigue, and widespread body pain that cannot be diagnosed, the calcium value in the blood must be checked.
A blood calcium level above 10 mg/dL should raise suspicion of a parathyroid adenoma. High calcium can have serious effects on many systems in the body, especially the heart and blood vessels, and can lead to the formation of stones in the kidneys.
How is parathyroid adenoma diagnosed?
Parathyroid adenoma diagnosis is usually made through a series of blood tests and imaging methods. Your doctor will first evaluate your symptoms and then confirm the diagnosis with various examinations.
Blood tests: Calcium and PTH levels
The first step in diagnosing parathyroid adenoma is blood tests. During these tests:
The calcium level is measured. A calcium level above 10 mg/dL raises suspicion. This value must be high at least twice, as technical errors during blood collection can also cause high values.
The parathyroid hormone (PTH) level is examined. While PTH is expected to be low when calcium is high, in parathyroid adenoma, both calcium and PTH are high. This means "something is not right."
Vitamin D level is also important. If vitamin D is low, the body may secrete excess PTH to compensate for this.
Also, when measuring the calcium value, it is important to look at it together with the albumin level. When albumin is low, the true calcium value is calculated with a formula: Corrected Ca = Measured total Ca + .
Along with these examinations, calcium excretion in 24-hour urine is also measured. In parathyroid adenoma, an increase in the amount of calcium excreted in the urine is observed.
Imaging methods: Ultrasound, scintigraphy, MRI
When suspicion of parathyroid adenoma arises with blood tests, imaging methods come into play:
Neck ultrasonography (USG): It is the first imaging method used. A "hypoechoic" (dark-looking) mass can be seen behind or next to the thyroid gland. It is possible to locate the adenoma in 75-80% of patients with ultrasound.
Parathyroid scintigraphy: It is performed by injecting a radioactive substance called Technetium-99m sestamibi intravenously. This substance is retained in the parathyroid tissue and shows the adenoma as a "glowing spot." The success rate is between 60-90%.
Other advanced imaging techniques: In patients whose adenoma cannot be found with ultrasound and scintigraphy, computed tomography (CT), 4D-CT (four-dimensional computed tomography), or magnetic resonance imaging (MRI) are used.
Choline PET
The main purpose of these imaging methods is to determine the exact location of the adenoma before surgery. Sometimes the parathyroid gland may not be in its normal location, it may be in an "ectopic" position, or it may be very small. In these cases, more advanced hybrid imaging techniques such as SPECT/CT can be used.
Incidental diagnosis in asymptomatic cases
Today, approximately 50% of parathyroid adenoma cases are diagnosed incidentally without showing any symptoms. This situation usually starts with:
Noticing "high calcium" values during routine blood tests
It may be revealed during examinations performed while checking "whether there is osteoporosis or not"
It can be detected in tests performed as part of a general health check-up
In asymptomatic (symptomless) hyperparathyroidism patients, serum calcium may be slightly high, 1.5-2 times higher than normal, or close to the upper limit of normal.
Especially in mild cases, parathyroid adenoma can progress silently for years without showing any symptoms. Therefore, checking the calcium level during routine blood tests is important for catching this hidden disease in the early period.
What is parathyroid surgery and how is it performed?
The most effective treatment for parathyroid adenoma is surgery, and this treatment method is based on the removal of the diseased parathyroid gland. When performed in experienced hands, parathyroid surgeries have a success rate of over 95%.
Pre-operative preparation process
Preparation before parathyroid surgery begins with a detailed evaluation. First, your calcium and PTH levels are checked. In addition, kidney function tests are performed and your general health status is reviewed. Furthermore, your suitability for anesthesia is evaluated by an anesthesiologist.
You are usually asked to fast on the night before the surgery. You may need to temporarily stop using some medications. Your doctor will provide you with detailed information about the pre-operative preparation process.
Determining the location of the adenoma
Determining the location of the adenoma before surgery is very important. Imaging methods such as ultrasonography, scintigraphy, or 4D-CT are used for this. This ensures that the surgeon can reach the diseased gland directly during the surgery.
Sometimes parathyroid glands can be located in different positions than they should be during embryological development. An experienced surgeon knows these possible locations and checks them during the surgery.
Surgical techniques and incision site
Parathyroid adenoma surgery is basically performed using two main methods:
Minimally Invasive Parathyroidectomy (MIP): If the location of the adenoma has been determined beforehand, it is performed by making a small incision of approximately 2-3 cm on the front or side of the neck. The advantages of this method include a smaller scar, less pain, and faster recovery.
Traditional Neck Exploration: If the location of the adenoma could not be determined or if it is suspected that there is a problem in more than one gland, the surgeon makes a wider incision in the neck and examines all four parathyroid glands.
Surgery duration and anesthesia
Parathyroid surgery is usually performed under general anesthesia. The duration of the surgery can vary between 30 minutes and 3 hours, depending on the location of the adenoma and the surgical technique. While the surgery is short in simple cases, the duration may be prolonged in cases where there is difficulty in determining the location of the adenoma.
Post-operative recovery process and points to consider
Following a successful parathyroid adenoma surgery, the recovery process requires careful follow-up both in the hospital and at home. Paying attention to some important points during this period will help you regain your health faster.
Length of hospital stay
You may usually need to stay in the hospital for 1-2 days after parathyroid surgery. During this time, you are regularly checked by the healthcare team, and your pulse, blood pressure, and breathing are monitored. You can start drinking water a few hours after the surgery, and you can switch to normal food in the following hours depending on your nausea status.
It is recommended that you get up and take short walks within the first 24 hours after the surgery. However, since you may experience low blood pressure due to the effect of anesthesia, it will be safer to sit up first and then stand up slowly.
Wound care and pain management
Your surgical wound is usually covered with a small bandage, and you can remove this dressing 48 hours after the surgery. There is no harm in taking a bath after this time; soapy water can touch your wound, but you should not use a loofah.
Every surgery is a controlled injury, and it is normal to have mild pain after the surgery. You can spend this process more comfortably by using the painkillers recommended by your doctor. You may feel a slight sensation of obstruction when swallowing, which is also normal.
Sometimes thin tubes called drains may be placed during the surgery. These are usually removed easily within 24 hours after the surgery and do not cause pain.
Monitoring calcium levels
The most critical point in the post-operative period is the regular monitoring of your blood calcium levels. Blood is drawn within the first 24 hours after the surgery to measure your calcium values, and calcium medication and vitamin D are given if necessary.
Calcium values will return to normal within 24-48 hours after the surgery. In some patients, blood calcium levels may drop below normal due to calcium hunger. In this case, calcium monitoring is continued for 48-72 hours and calcium supplementation is given.
If symptoms such as numbness or tingling in the hands develop, you should inform your doctor immediately.
Return to physical activity
The recovery process varies from person to person and according to the scope of the surgery. It is recommended that you limit your neck movements and avoid lifting heavy objects during the first week. Light walks will help your recovery.
You can usually return to your daily activities one week after the surgery. However, your full recovery may take longer in some cases. While most patients return to their normal lives within 7-10 days, full recovery can take up to 1 month.
Regular doctor check-ups
Regular post-operative check-ups are very important to evaluate the success of the treatment. Your first check-up is usually done within the week after you are discharged.
Your parathyroid levels and calcium levels need to be monitored after the surgery. It is recommended that you do not skip your check-ups at six-month intervals, especially during the first 2 years. During these check-ups, your doctor will evaluate your recovery process and provide necessary advice.
In summary, Parathyroid Surgery
As a result, parathyroid adenoma is a treatable health problem and can be successfully cured when diagnosed correctly. Surgeries performed by experienced surgeons have a success rate of over 95%, and the vast majority of patients get rid of their symptoms after the surgery.
Do not worry when you receive such a diagnosis. Parathyroid adenoma surgery is usually a short procedure performed with a small incision. Furthermore, the hospital stay after the surgery is only 1-2 days, and most patients can return to their normal lives within a week.
It is very important to monitor your calcium levels during the post-operative recovery period. Therefore, you should have the check-ups recommended by your doctor regularly without skipping them.
Many patients provide feedback such as "The weakness, fatigue, and pains I have been experiencing for years have passed." If you are also experiencing fatigue, widespread body pain, and bone problems, it may be beneficial to have your blood calcium value checked.
Remember that early diagnosis is very important in the treatment of parathyroid adenoma. This problem, which can be detected with a simple blood test, can be completely solved when intervened in time. We wish you healthy days!
Frequently Asked Questions
How long does parathyroid surgery take? The surgery usually takes 1-2 hours, and this duration may vary depending on the type of procedure and the surgeon's experience.
How long do you stay in the hospital after the surgery? Staying in the hospital for 1 day is usually sufficient.
Is there pain after the surgery? Mild pain after the surgery is normal and can be controlled with painkillers.
What should I pay attention to after the surgery? Follow your doctor's recommendations, limit your neck movements, and avoid lifting heavy objects.
Is hoarseness permanent after the surgery? Hoarseness is a rare condition and is usually temporary.
Do I need to take calcium supplements? If your calcium level drops after the surgery, your doctor may recommend calcium supplements.
Can hyperparathyroidism recur? It can rarely recur. Especially in the presence of a double adenoma, when the larger one is removed, the other may become active. Therefore, follow-up for 2 years after the surgery is important.
Which doctor performs the surgery? It is performed by general surgeons, but it is more appropriate to prefer surgeons who specialize in endocrine surgery.
Is there a risk of infection after the surgery? Parathyroid surgery falls into the clean surgery group, and the risk of incision site infection after the operation is quite low.
Parathyroid adenoma surgery is performed with a small incision in the neck and is usually carried out under general anesthesia. Learn about the post-operative recovery process and points to consider.
