Parathyroidectomy

The goal of the surgery is to restore normal parathyroid hormone (PTH) and calcium levels in the body by removing one or more parathyroid adenomas.

By definitively addressing the problem, the procedure ensures normal function of the nervous and muscular systems and helps maintain bone health.

In the typical case of primary hyperparathyroidism, early surgical intervention is recommended to prevent serious complications affecting multiple organ systems, such as:

• Increased bone fragility, osteopenia or osteoporosis, and risk of fractures
• Kidney stones or “sludge” in the urine, impaired kidney function
• Fatigue, muscle weakness, depression, difficulty concentrating, and psychological discomfort
• Gastrointestinal disorders, risk of peptic ulcers, pancreatitis
• Potential malignancy

Persistently high levels of calcium and parathyroid hormone (PTH) in the body act like a “time bomb.” Even mild or absent symptoms do not prevent the progression of the disease, which can have destructive effects on the heart, brain, kidneys, and skeleton.

Even asymptomatic patients can benefit from surgery, as parathyroidectomy definitively eliminates the cause of hypercalcemia, preventing future complications and improving overall health and well-being.

The final decision is always made in collaboration with your physician, based on clinical findings, laboratory results, and the patient’s overall condition.

In medical practice, prompt resolution of a diagnosed problem that disrupts vital bodily functions, sometimes in an irreversible way, is considered important. Early intervention helps prevent long-term complications and preserves overall health.

During the surgery, the surgeon locates and removes the affected parathyroid gland, while typically identifying and preserving the remaining normally functioning parathyroid glands.

A rapid intraoperative biopsy is performed to histologically confirm the success of the procedure.

Of course, it is possible to perform thyroidectomy and parathyroidectomy simultaneously in a single operation, provided that both organs are affected. This is feasible because the thyroid and parathyroid glands are anatomically adjacent.

The appropriate specialist is an endocrine surgeon, and even more specifically, a surgeon who has focused scientifically on endocrine surgery of the neck, meaning the endocrine glands located in the cervical region.

Today, parathyroid surgery can be performed using various techniques. Unfortunately, the traditional approach with large incisions, drains, and prolonged recovery is still commonly encountered.

Dr. Karvounis applies minimally invasive parathyroidectomy, a modern and innovative technique successfully used internationally in specialized endocrine surgery centers.

Instead of traditional scalpel and scissors, the dissection and removal of the affected parathyroid gland, along with hemostasis, are performed using radiofrequency and ultrasonic energy (Ultracision). These advanced surgical tools provide maximum precision and effectiveness, minimizing tissue injury and significantly reducing postoperative pain compared to conventional surgery.

Additionally, voice protection is ensured through neuromonitoring, a revolutionary technique that alerts the surgeon and protects the patient’s vocal cords with a high safety margin. Additionally, video-laryngoscopy during patient awakening provides a second confirmation of vocal cord integrity.

Furthermore, the intraoperative parathyroid hormone (PTH) measurement is an extremely valuable tool for surgeons familiar with it and in clinics equipped to support it, enabling a highly successful, targeted, minimally invasive parathyroidectomy.

This is a modern technique used to monitor and confirm the success of a parathyroidectomy during the surgery itself. It is based on evaluating the drop in PTH levels by comparing a baseline value at the start of the operation with the PTH level a few minutes after removing the affected gland. By following a scientific protocol, the surgeon can certify the success of the parathyroidectomy before the patient even awakens from anesthesia.

Dr. Karvounis has the distinction of being the first Greek surgeon to publish a pioneering scientific study on this method in the official journal of the Hellenic Surgical Society, based on a large series of iPTH-guided parathyroid surgeries performed in London.

Parathyroidectomy is a highly delicate surgical procedure that should ideally be performed by a specialized endocrine surgeon. The main challenge lies in locating the diseased gland, which is often lentil-sized and closely resembles the surrounding fatty tissue and nearby lymph nodes. This is why it is crucial for the surgeon to have extensive experience in tertiary endocrine surgery centers, accumulating expertise from a large number of similar operations.

The anatomical position of the affected parathyroid gland is highly variable and unpredictable, and it is closely related to laryngeal nerves (vocal cords), the esophagus, and the carotid artery, making the procedure especially demanding.

Dr. Karvounis, leveraging his extensive experience in parathyroid surgery abroad, has successfully performed reoperations in Greece for patients who previously underwent one, two, or even three unsuccessful surgeries elsewhere, where the diseased gland had unfortunately not been located and removed.

In some cases, a parathyroid gland may not be located in its usual anatomical position but instead in an ectopic location. Possible locations include the mediastinum, intrathymic (within the thymus), intrathyroidal, tracheoesophageal groove, carotid sheath, and others.

Detailed preoperative mapping by a radiologist is crucial for identifying the parathyroid lesion. Additionally, anatomical variations may include the presence of a supernumerary parathyroid gland.

In these special anatomical circumstances, it is essential to perform a meticulous surgical procedure by a specialized endocrine surgeon with extensive experience and intraoperative use of modern techniques, in order to locate and safely remove the ectopic parathyroid gland.

Typically, the procedure lasts less than one hour. However, if locating the diseased gland requires additional time, the duration of the surgery may be extended accordingly.

Parathyroidectomy is usually performed under short-duration general anesthesia. In selected cases, based on specific criteria, it can also be performed under local anesthesia combined with sedation.

Dr. Karvounis, as part of his minimally invasive surgical practice, was recognized for his clinical work titled “Minimally Invasive Parathyroidectomy under Local Anaesthesia” (E. Karvounis and J. Lynn) at an International Surgical Forum in 2002.

No, a blood transfusion is not required and blood donors are not needed for this procedure.

No. With this minimally invasive surgical technique, in the vast majority of patients, no drain is placed after the procedure.

Patients can usually start eating approximately 2 hours after the surgery.

There are no dietary restrictions.

Absolutely. Patients are able to speak immediately after the procedure is completed.

The difficulty of the procedure varies depending on the location of the diseased gland and the patient’s anatomy. The primary goal is to locate the lesion and safely remove it, avoiding bleeding or injury to surrounding structures (the laryngeal nerves, trachea, and esophagus).

When the surgery is performed by an experienced, specialized surgeon using modern technological equipment, the ability to accurately locate and remove the lesion is greatly enhanced, and the risk of affecting speech is minimized.

No. The goal of the surgery is for the body to maintain normal calcium levels on its own after the procedure.

No. With this surgical technique, the procedure does not cause pain. In fact, painkillers are often not even prescribed at the time of patient discharge.

Typically, 24 hours or less. The patient arrives at the clinic in the morning, undergoes the surgery, and by midday, the IV line is removed. Immediately after surgery, patients can speak, move around, and start eating within a short time. Without drains or other tubes, they are free to move and can usually be discharged the same day or the following day.

In rare cases, after removal of the overactive gland, a rapid postoperative drop in calcium levels may occur. While this confirms the success of the surgery, it may require the patient to stay an additional night for calcium levels to stabilize safely.

Return to work depends entirely on the individual. Recovery after the procedure is usually very quick and painless.

Many of our patients go to work the day after discharge. Others may prefer to take sick leave, in which case the doctor and patient determine together the appropriate duration.

Parathyroid cancer is very rare. However, hypercalcemia (if the diseased parathyroid is not removed) is a factor that may contribute to the development of cancer in other organs.

Aesthetic outcome is a top priority. At the end of the surgery, the incision is carefully closed with plastic surgical techniques, without external stitches that need removal. The incision is extremely small and placed along a natural skin crease of the neck, allowing it to blend harmoniously with the surrounding skin.

Dr. Karvounis has further refined this technique and, when needed, recommends special cosmetic healing products to promote rapid recovery and enhance the natural appearance of the skin.

Very often, just a few days after surgery, patients report that friends ask, “Where did you scratch yourself?” rather than noticing they had surgery, thanks to the almost invisible scar. In a few months, the scar becomes so subtle that patients often have to convince others that they actually underwent surgery.

The goal of parathyroidectomy is the complete removal of the pathological parathyroid tissue, which ensures a definitive solution in the vast majority of cases. In a very small percentage of patients, parathyroid disease may recur in the future, although it is not possible to predict this at the time of the initial surgery.

Persistent hypercalcemia can cause fatigue, weakness, general malaise, headaches, sleep disturbances, depression, difficulty concentrating, memory problems, hair loss, and gastroesophageal reflux.

It can also lead to elevated blood cholesterol, increased risk of stroke, cardiac arrhythmias, and hypertension. Additionally, it promotes kidney stones and osteoporosis, which often results in bone fractures.

High calcium levels are also associated with an increased risk of developing cancers of the breast, colon, kidney, and prostate.

Parathyroidectomy is a highly successful surgical procedure with minimal risk of complications.

This targeted, safe, and effective intervention provides a definitive solution to the problem and significantly improves the patient’s quality of life.

Patients often describe their experience after parathyroid surgery as feeling “reborn.” Vague feelings of fatigue and a general sense of low mood usually disappear after the procedure. Many patients notice a pleasant improvement in daily life, mood, and energy levels, and over time, postoperative recovery can even restore pre-existing issues (e.g., osteopenia).

Dr. Evangelos Karvounis, MD, PhD, FACS, is an award-winning endocrine surgeon, Doctor of Medicine from the University of Athens, and a Fellow of the American College of Surgeons. He currently serves as the Director of Endocrine Surgery at the Euroclinic of Athens. The experienced surgeon is available to answer any questions you may have regarding parathyroidectomy. Contact Dr. Karvounis today, either by phone or by completing the contact form, and schedule your appointment for accurate diagnosis and personalized treatment.