The parathyroid or parathyroid glands, as the name implies, are endocrine glands located in the neck, behind the lobesbehind the thyroid lobes. They produce parathyroid hormone (PTH), which helps the body maintain the balance between calcium and phosphorus, among other things.
At a general level, the functionality of PTH can be summarized on the following fronts: in the bone it activates the function of osteoclasts, to increase calcium resorption (loss) from the bone and thus raise its blood concentration. On the other hand, in the kidney it activates calcium reabsorption and phosphorus excretion, while in the intestine it promotes the absorption of the mineral at the level of the intestinal mucosa.
Thus, in excess this hormone produces hypercalcemia (excess of circulating calcium) while its deficit causes hypocalcemia (low levels of the mineral). Parathyroid cancer, hyperparathyroidism and hypoparathyroidism are the best known pathologies related to this glycogenic conglomerate. related to this glandular conglomerate. If you want to know when the removal of the parathyroid glands becomes necessary and what are their effects on the organism, continue reading.
When is it necessary to remove the parathyroid glands?
The parathyroid glands are 4 organs the size of a pea, measuring approximately 5x3x3 millimeters and weighing 30 milligrams each. They are located in the neck, near the thyroid gland (hence their name).
As we have said in introductory paragraphs, the parathyroid glands are essential for regulating the mechanisms of absorption and excretion of circulating calcium and phosphorus.. Their removal is sometimes necessary, as an excess of parathyroid hormone in the blood can lead to the following events:
- OsteoporosisOsteoporosis: as PTH stimulates bone resorption, bones become fragile, brittle and break easily. For this reason, untreated parathyroidism often leads to osteoporosis in severe cases.
- Kidney stonesWhen there is too much calcium in the blood, solid calcium deposits may form in the kidneys.
- Cardiovascular diseaseThe physiological mechanism is not entirely clear, but it appears that excess circulating calcium is associated with cardiovascular disease and arterial hypertension.
- Neonatal hypoparathyroidismExcessive circulating calcium in the mother can deprive the fetus of healthy levels of the mineral.
As can be seen, some of these complications can seriously endanger the life of the patient and their offspring. Below, we will explore two of the most important pathologies that require removal of the parathyroid glands. Do not miss it.
Hyperparathyroidism is a pathology that arises from the arises from an overproduction and secretion of PTH by the parathyroid glands.. This disease can be primary or secondary, with different underlying reasons in each case.
Primary hyperparathyroidism is that which occurs when circulating blood calcium levels are normal. Calcemia (healthy blood calcium level) is tightly regulated with total calcium values between 2.2-2.6 mmol/L (9-10.5 mg/dL), and ionized calcium of 1.1-1.4 mmol/L (4.5-5.6 mg/dL). Despite this mineral “normality”, the parathyroids produce more parathyroid hormone than they should.
The approximate prevalence of this variant is 1-3 patients per 1,000 individuals in the general population, with a clear of the general population, with a clear preference towards the female gender (2:1 ratio). In addition to this, the highest frequency is observed after the age of 60 years. The most common causative agent is the development of adenomas, benign tumors that form in the parathyroids.
On the other hand, secondary hyperparathyroidism occurs when, in fact, circulating calcium levels are lower than they should be. This variant is usually linked to chronic renal insufficiency, as up to 20% of those who suffer from it end up developing secondary hyperparathyroidism. There are also more varieties, although these two are the most medically relevant.
2. Parathyroid cancer
Parathyroid cancer is an exceptionally rare type of neoplasm that occurs when malignant cells form in the parathyroid tissue, resulting in the formation of tumors. 85%-95% of tumor processes in these glands are benign (the previously named adenomas). (the previously named adenomas), while only 3% of cases are attributed to parathyroid cancers.
This type of neoplasm affects men and women equally, although it is much more common in people over 30 years of age. The underlying causes are not known, but it is suspected that certain genetic diseases or exposure to radiation treatments may favor its appearance.
What does the removal of the parathyroid glands consist of?
Surgery may be necessary for both pathologies, depending on the patient’s condition and the progression of the disease. The parathyroid glands are usually removed through a 5 to 10 centimeter surgical incision in the center of the neck..
It should be noted that it is not usually necessary to remove all 4 parathyroid glands at the same time. The surgeon can select only one of them and, by means of a minimally invasive procedure (a 2-3 centimeter cut) it is removed without touching any other anatomical structure. Fortunately, this is sufficient to treat primary hyperparathyroidism in 6-7 out of 10 patients. This operation is known as selective parathyroidectomy.
In rare cases where all 4 (or rather 3 and a half) glands must be removed, one of them is selected and a portion is transplanted to the forearm or next to the thyroid. This is done to ensure that the patient continues to produce PTH hormone, in order to maintain stable blood calcium levels..
Based on the invasiveness of the process and how many glands are to be removed, the postoperative period can be outpatient (the same day of the operation the patient is at home) or with a short admission of 1 to 3 days duration. It should be noted that parathyroidectomy is very painless and does not usually require more than 3 doses of painkillers to manage the discomfort it causes. Daily activities can be resumed a few days after the procedure and complete healing is achieved in 1-3 weeks.
Risks of parathyroidectomy
As with any surgical procedure, there are certain risks inherent to this operation. For example, during the operation the patient may experience adverse reactions to medications, breathing problems, uncontrolled bleeding, clot formation and an increased risk of infectious processes. These types of problems are not commonbut they need to be mentioned anyway.
Another accessory condition that is somewhat more common is the involvement of the vocal cord nerves, due to their proximity to the parathyroid glands. Approximately 5% of patients have transient aphonia after surgery, usually lasting 2-10 weeks. More rarely (in 1-2% of the most complicated cases) this aphonia and phonatory weakness are permanent.
The latter risk, although extremely rare, is very dangerous. The patient may present with severe shortness of breath after the procedure. Fortunately, it almost always disappears several weeks or months after the operation.
What to do in case of hypoparathyroidism?
We have said that there are 3 typical diseases of the parathyroid glands: cancer (related to primary hyperparathyroidism in a few cases), hyperparathyroidism and hypoparathyroidism. Removal of the parathyroid glands may be the solution for the first two pathologies but it certainly does not address hypoparathyroidism.
When too little PTH is produced, circulating calcium levels fall and phosphorus levels rise. This is usually the product of a misdirected autoimmune attack that damages the parathyroid hormone-producing cells.
In patients with hypoparathyroidism, calcium carbonate and vitamin D supplements are often used.supplementation, which may be necessary for life. PTH injections may also be useful in some patients and even intravenous calcium administration in the most severe events.
The parathyroid glands are essential for the proper functioning of the body and bone integrity of the individual, as they directly regulate the proportion of circulating calcium, with all that this entails. Unfortunately, when PTH is produced in excess, various symptoms of varying severity may appear, osteoporosis being one of them.osteoporosis being one of the most striking.
For this reason, it may sometimes be necessary to remove one or more parathyroid glands. In any case, all 4 are not completely removed, as it is necessary for at least one segment of one of them to continue to produce PTH to maintain stable blood calcium levels and thus avoid hypocalcemia.