Parathyroid glands are glands located in the neck, in close proximity to the thyroid gland, and secrete a hormone called parathyroid hormone. There are usually 4 parathyroid glands, which are 3-4 mm in size. Parathyroid glands; It manages calcium metabolism in the body by acting on the intestines, bones and kidneys. tall; They are behind the thyroid gland, roughly in the right and left, lower and upper neighborhoods of the thyroid gland, and in close proximity to the arteries entering the thyroid and the nerves called Nervus Laryngeus Recurrence (vocal nerve), which enable breathing and making sounds.
Parathyroid adenoma; It is the enlargement and overactivity of usually one of the glands, and in rare cases more than one gland. While approximately 85% or more cases have disease in a single gland, in 15% of cases, adenomas may be found in more than one gland (usually in two glands) or enlargement in all four glands. It is twice as common in women than in men.
When the parathyroid gland works excessively and too much parathyroid hormone is secreted, calcium dissolution from the bone increases and the calcium level in the blood increases. Osteoporosis, bone pain, bone fractures due to simple reasons, kidney stones, ulcers and gastritis in the stomach and duodenum, inflammation of the pancreas gland, constipation and nausea, muscle weakness, hypertension, decrease in pulse rate, early fatigue, weakness, difficulty concentrating. , memory disorders and psychiatric disorders (such as depression, mood disorders) develop.
Hypercalcemia is diagnosed when blood calcium is high at least twice. Although the normal value of blood calcium varies from laboratory to laboratory, it is generally between 8.5-10.5 mg/dl. In the elderly and those with comorbidities, the corrected calcium level should be calculated together with the albumin value. If serum calcium and parathormone levels are high and serum phosphate level is decreased, primary hyperparathyroidism is diagnosed. In differential diagnosis; familial benign hypercalcemia (AHH), lithium-induced hypercalcemia, vitamin D deficiency, etc. It should be checked whether there is any disease or not.
Imaging methods are required if the patient is to undergo surgery. Usually parathyroid gland adenomas are diagnosed by ultrasonography. It is possible to diagnose with ultrasound in 75-80% of patients.
Although it is not necessary in every case, Parathyroid scintigraphy can be performed to determine the location of the swollen parathyroid gland. Although its sensitivity in detecting parathyroid adenomas varies widely, it is generally between 60-90%. In cases where adenoma cannot be seen with the above two methods, Computed tomography (CT) or neck Magnetic resonance imaging (MRI) can be performed.
Authorities state that Parathyroidectomy surgery is the only fully curative method and that it is safe. and reported that it was cost effective. In a patient with high blood calcium (hypercalcemia) who has no symptoms, the incidence of complications such as osteoporosis, kidney stones and other complications that occur throughout the body listed above is between 20-63% within 10 years. Surgical treatment prevents these from occurring. When deciding on surgery in asymptomatic patients, the first features to look for in surgical treatment are; 1. Patients younger than 50 years of age, 2. Patients who cannot come to a doctor's check-up for a long time, 3. Those whose serum calcium is more than 1 mg/dl higher than normal, 4. Those whose urine calcium levels are more than 400 in 24 hours, 5. Those whose kidney functions are at least In those with a 30% decrease, 6. In those with primary hyperparathyroidism complications (such as kidney stones, osteoporosis and serious psychoneurological disorder), surgical treatment should be considered as stated above.
When performed in experienced hands, these surgeries should be considered. The cure rate is 95% and above. Complications of surgical treatment; recurrent nerve injury (deepening of voice, difficulty in breathing), persistent or recurrent hyperparathyroidism, permanent hypoparathyroidism (low functioning of the parathyroid glands) and bleeding. However, these are seen at a low rate. Since parathyroid glands are difficult to find during surgery due to their color, size, and especially their proximity to vessels and nerves, it becomes difficult to evaluate the surgical field in case of the slightest bleeding, and it may sometimes become impossible to find these glands, or undesirable injuries such as vessels and nerves may occur while searching for parathyroid glands. it could be. Therefore, it should be performed in experienced hands.
Open parathyroidectomy (traditional): It is the removal of one or more of the parathyroid glands through an incision made in the neck. Although adenomas are mostly in one gland, some patients have more than one tumor, called double adenoma, in 5-10% of cases. Adenoma may be seen in many glands. In these cases, more than one gland must be removed. Removal of all glands is not necessary except for underlying conditions such as chronic kidney failure. The surgery is similar to thyroid surgery; both sides of the thyroid gland in the neck are checked, all glands are found and evaluated, and the diseased gland or glands are removed. Minimally-invasive parathyroidectomy (MIP): 1.5-2 cm directly above the diseased parathyroid gland in the location determined by ultrasonography or scintigraphy in the neck. An incision is made. Since the incision is small, other parathyroid glands are usually not examined in this surgery. In both forms, called “frozen examination”; Pathological examination should be performed during surgery. Determining whether the removed tissue is parathyroid tissue by performing a rapid pathological examination during the surgery prevents unnecessary waste of time.
Persistent or recurrent hyperparathyroidism: Parathormone persists to be high in the first 6 months after the surgery. It is called hyperparathyroidism. Preoperative evaluation may be incomplete, or not enough tissue may be removed during surgery. Recurrence of hyperparathyroidism 6 months after surgery is called recurrent hyperparathyroidism. When publications are examined all over the world, it is seen that hyperparathyroidism continues after surgery in approximately 3-4% of patients. In persistent or recurrent parathyroid adenomas, it would be appropriate to perform examinations accordingly, keeping in mind that parathyroid tissue develops in fetal life (in the womb) and has different locations within the chest cavity. Since these are very rare, it is not necessary to investigate the chest cavity during initial examinations or surgery. In the second surgery, it would be appropriate to investigate the chest cavity in addition to the neck.
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