The most effective treatment for hyperparathyroidism is a parathyroidectomy. During this surgical procedure, one or more overactive parathyroid glands are removed. This surgery successfully cures up to 95 percent of cases of hyperparathyroidism, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

After a parathyroidectomy, most patients experience normal levels of parathyroid hormone (PTH) production and are able to maintain normal levels of calcium in the blood. As a result, the symptoms of hyperparathyroidism pass and the patient no longer experiences fatigue, bone damage and kidney disease due to the disorder. Patients  can also experience increases in bone density, improved muscle strength, as well as a reduced risk of kidney stones..

A parathyroidectomy is the only effective way to cure hyperparathyroidism. Patients who have overactive parathyroid glands but are not yet experiencing symptoms may still be advised by a physician to undergo a parathyroidectomy to prevent future complications.

Before surgery, imaging tests may be performed to identify the gland or glands that need to be removed. However, imaging techniques are not perfect methods for identifying which gland is overactive and, in most cases, it is more effective for a surgeon to decide which glands to remove during the parathyroidectomy.

The procedure may be minimally invasive if the overactive gland can be identified prior to the procedure. This may be done with the use of a special imaging test called the sestamibi, in which patients ingest a radioactive liquid just before images are taken of the parathyroid area. These images may help guide a physician during surgery. The advantages of a smaller incision with a minimally invasive procedure are a shorter time in the hospital and a smaller scar.

A parathyroidectomy may be performed under general or local anesthesia and takes roughly three hours to perform. During the procedure, the patient is anesthetized and an incision is made near the base of the patient’s neck over one pair of parathyroid glands. If the initial incision reveals the overactive gland and a normal gland, the overactive one is removed. The patient’s PTH level may then be tested and compared to prior readings. If the level has decreased, then the overactive gland causing the increase has most likely been removed and the incision can be closed. In some cases, multiple parathyroid glands may need to be removed or imaging tests may not reveal which one is overactive. For this, a larger, more invasive incision is necessary to access all four glands.

When three and a half or all four parathyroid glands need to be removed from the neck, one may be transplanted to the patient’s forearm. The gland will continue to produce PTH, reducing the risk of hypoparathyroidism (when the glands fail to produce enough PTH). Placing a functioning gland in the arm also allows easy access by a surgeon if it becomes overactive.

Recovery from a parathyroidectomy typically requires an overnight stay in the hospital, although patients who undergo a minimally invasive procedure may be allowed to go home within hours of the operation. Immediately after surgery, a patient’s neck is likely to be swollen, and blood calcium levels may be low until the remaining glands are able to compensate for the removed tissues. These low calcium levels are treated with calcium supplements.

Typically within 24 hours, the patient’s PTH and calcium levels return to normal. Within the next two to three days, the bandages are removed from the neck. A week after the surgery, the patient returns to the physician for a checkup and to have the sutures removed.

The checkup is important because in some cases the remaining parathyroid glands are not able to recover and produce enough PTH. If this occurs, the patient may have signs or symptoms of hypoparathyroidism, such as muscle spasms and tingling in the lips, fingers and toes.

As with all surgeries, there is a risk of complications due to a parathyroidectomy. However, complications are rare. Some of these complications (e.g., blood loss, infection, adverse reaction to anesthesia) may occur with any type of surgery. Other complications are specific to a parathyroidectomy, such as:

• Hoarseness or difficulty swallowing (due to injury to the nerves of the voice box)
  
  
• Hypoparathyroidism (due to too much parathyroid gland being removed)
  
  
• Recurrence of hyperparathyroidism