Table of contents
Parathyroid adenoma
Parathyroid glands, 2-3 mm in size and 30-40 g, are located behind the thyroid gland and are usually 4 in number, 2 on the right and 2 on the left. Parathyroid glands secrete parathormone and act as the main factor in blood calcium balance. It also has important functions in blood phosphate balance and vitamin D metabolism.
Although parathyroid adenoma can be encountered at any age, it is more common in older women after menopause.
Parathyroid adenoma is a benign tumor of the parathyroid glands. Parathyroid adenoma patients have increased blood parathormone and calcium levels. An increase in blood calcium levels can cause serious problems affecting all body systems.
High blood calcium levels can lead to osteoporosis and easy fracture in the future. These patients may also experience symptoms such as abdominal pain, nausea, vomiting, formation of kidney stones, stomach diseases, weakness, constipation, visual disturbances, loss of strength, and high blood pressure.
Diagnosis of parathyroid adenoma
Parathyroid adenoma can often be confused with other diseases until the diagnosis is made. For example, it can be confused with rheumatic diseases due to bone and muscle pain and psychological problems due to calcium imbalance. Therefore, in cases of persistent hypercalcemia, parathyroid adenoma and even parathyroid carcinoma should be considered.
Parathyroid adenoma can be diagnosed by radiological examinations (ultrasonography and scintigraphy). In some patients, biopsy may be required to differentiate between adenoma and cancer. It may even be necessary to scan a large area with computed tomography or magnetic resonance imaging methods.
Treatment of parathyroid adenoma
Parathyroid adenoma is a disease that can be treated with surgical methods. By surgical methods, the parathyroid gland is removed and thus the blood calcium ratio is reduced to normal.
In some cases where parathyroid adenoma is limited, minimally invasive procedures are preferred. Minimally invasive parathyroidectomy (MIP) is 95% successful in experienced hands and when patient selection is well done. Recovery is fast. The advantages of this procedure are that the postoperative pain is minimal, the cosmetic result is better, the hospital stay and return to work are shorter, and it can be performed with local anesthesia if desired. The ROLL technique (radioguided occult lesion localization) used during surgery is another method that increases the success of MIP. On the morning of the surgery, an injection is made into the parathyroid adenoma under ultrasound guidance. During the surgery, this injection is followed by a hand tool called a gamma probe, and the lesion is directly detected. With this method, the duration of the operation is shortened and the success of the treatment increases.
In some cases, the size of the adenoma may not be clarified and growth may be seen in all four parts. Sometimes the parathyroid glands may be embedded in the thyroid gland. In such uncertain and risky situations, surgical cleaning with the thyroid gland may be required.
Since the secretion of parathormone will decrease after parathyroidectomy, patients may need to be supplemented with calcium and vitamin D for a while, and follow-up is very important in this process. If thyroid resection is also performed, thyroid hormones may need to be used in addition to the treatment.
Calcium deficiency is common in these patients after surgery. Tingling around the lips, numbness in the fingertips and sometimes spasms can cause pain in the bones. Calcium and vitamin D supplementation given to those with temporary calcium deficiency can often be applied at home and does not require hospitalization.
The success of surgery in the treatment of parathyroid adenoma is quite high. Most patients can be discharged from the hospital on the day of surgery or the day after.
Complications of surgical treatment
There is a small chance of nerve injury during surgical removal of a parathyroid adenoma. In these patients, deepening of the voice and difficulty in breathing may occur. Other complications are the possibility of recurrent hyperparathyroidism. Because even a very small amount of parathyroid gland remains, the remaining tissue can develop itself and recreate a similar picture. In addition, patients may experience permanent hypoparathyroidism and bleeding. However, surgical treatment complications occur very rarely and are rarely seen in mini-invasive radioactive material-guided surgeries.