Cells are the basic building blocks of the tissues and organs of our body. Usually, these cells divide to make new cells in a controlled manner, and beyond a point, the cells are replaced with new cells. This is how our bodies grow, heal and repair. Sometimes, this orderly growth of cells can go wrong due to the mutation or sudden change in the genes which control how cells behave. This can make the cells divide abnormally, producing more abnormal cells, forming a lump called a tumour. These cells cannot stay together, can easily detach from each other and spread via direct contact, lymphatics and bloodstream to different organs in the body.
Parathyroid glands are 4 small pea-sized glands located adjacent to 4 poles of the thyroid gland in front of the neck. The parathyroid glands secrete parathyroid hormones, which help regulate the calcium and phosphorus levels in the blood.
Fig.1 Parathyroid glands seen near the thyroid gland over the neck
It is very rare tumor with incidence < 0.5%.
The reason why parathyroid neoplasms occur is not known in most people is not known and occur sporadically. They can occur in patients who are exposed to head and neck radiation early in childhood and those who have a strong family history like people with MEN (Multiple Endocrine Neoplasia) syndromes
Parathyroid neoplasms are diagnosed by a detailed history and a thorough clinical examination. The following investigations are also done
Fig.2 The scan shows the increased uptake in the neck indicative of a parathyroid adenoma
Parathyroid adenoma is a benign tumour of one of the parathyroid glands which produce more parathyroid hormones. This is the most common form of parathyroid tumours.
Parathyroid hyperplasia involves the enlargement of all four parathyroid glands. These glands produce excess parathyroid hormones resulting in excess calcium levels in the blood. They are frequently associated with MEN (Multiple Endocrine Neoplasia) Syndromes, a genetic disorder.
Parathyroid carcinomas occur as a malignant transformation of a parathyroid adenoma. They are very rare and usually diagnosed after exclusion.
Surgery is the most commonly used treatment modality for parathyroid neoplasms. Radiotherapy and chemotherapy are used rarely.
The parathyroids are seen very close to the thyroid glands and also the nerves responsible for good speech. Hence precise localisation of the tumour is important to avoid damage to the nerves responsible for speech and to avoid injury to the thyroid gland. Intra-operatively we inject Indocyanine green dye to localise the parathyroid glands.
The involved parathyroid gland is removed. This is called parathyroidectomy.
Fig. 3 A. Intra-operative picture of parathyroid adenoma
B. Post operative scar
Around three-fourths of the parathyroid glands are removed, minced and implanted in the forearm.
The parathyroid gland is removed along with adjacent soft tissue.
Facts at a glance about surgery and post operative instructions: ( May vary from person to person)
|Type of anaesthesia||: General Anaesthesia|
|Surgery time||: 1 - 2 hours|
|Hospital stay||: 1 - 2 days|
|Mobilisation||: 1st day|
|Normal Diet||: 1st day|
|Suture removal||: No suture removal required|
|Self-care||: 5 days|
|Full recovery||: 2 weeks|
|Return to work||: 2 weeks|