Parathyroid Adenoma

Parathyroid glands are bean-like formations, smaller than 5 mm, located on both sides of the neck, behind the upper and lower parts of the thyroid gland. They are usually four in number, but can sometimes be more numerous and in different locations. Their function is to regulate calcium metabolism. For this purpose, they secrete a hormone called parathormone.

Hyperparathyroidism is the most common endocrine disease in the population after diabetes and thyroid disease. It occurs in about 0.6% of cases and mostly in older women. In this condition, parathormone and consequently calcium levels in the blood increase. Calcium levels in the bones decrease, bones soften and fractures may occur. Kidney stones are also common in these patients.

The most common cause of primary hyperparathyroidism is the presence of a single parathyroid adenoma. It can also develop due to a condition called hyperplasia in which multiple glands grow. There are also secondary and tertiary types of hyperparathyroidism, especially in renal patients.

Determining the location of the enlarged parathyroid gland(s) is very important for the success of treatment. Therefore, ultrasongraphy and scintigraphy should be performed in every patient. If parathyroid adenoma or hyperplasia cannot be detected with these tests, further tests such as 4-dimensional computed tomography may be necessary.

The classical treatment method is surgery. However, sometimes it may not be possible to find a place for surgery, especially due to the small size of the gland or the presence of atypical localization. In such cases or depending on the patient's request, treatment can also be performed with ablation methods. Radiofrequency, which is a more controlled method, is generally preferred as an ablation method. Microwave ablation can also be applied if the practitioner is experienced. Ethanol ablation, which was previously used, is no longer preferred due to the risk of alcohol leaking into the surrounding tissue and not being very effective.

Ablation treatment of parathyroid adenomas is usually performed in as little as 10 minutes. However, it is slightly more risky than thyroid nodule ablation in terms of hoarseness. Because parathyroid glands are very close to the vocal nerve. For this reason, the parathyroid gland is isolated from the surrounding structures by giving sugar water (5% dextrose) and then ablation is performed. In this respect, the experience of the doctor is very important in parathyroid ablation.

If adequate ablation is achieved, parathormone level decreases in a short time. We follow our patients by measuring parathormone and calcium levels on the 15th day, 1st, 3rd and 6th months after the procedure. At the end of the 6th month, if parathormone and calcium levels are not completely normalized, the ablation procedure may be repeated.