Since hyperparathyroidism is caused by the development of a parathyroid tumor, the disease can be cured by removal of the tumor. Therefore, we do not to “treat” hyperparathyroidism; the goal is to cure it forever with a simple operation. Since 1925 it has been known that removal of the parathyroid tumor (the non-cancerous parathyroid adenoma) will stop the process of excess PTH production and almost immediately stop the calcium from being released from the bones. Within a few hours the high blood calcium will subside, and within a day or two most patients begin to feel better.
The operation invented in 1925 was a large incision across the neck that took 3-6 hours to complete. The operation was large because the parathyroid glands are often not next to the thyroid where they belonged, and because there are several nerves next to the parathyroid glands that could be injured, including the nerves to the vocal cords (recurrent laryngeal nerves). The surgeon would make a large incision almost from ear to ear so he/she could “explore” the neck looking for the parathyroid tumor. Believe it or not, this large, old-fashioned operation is still being performed in hospitals throughout the world today.
This type of operation carries a cure rate of about 90%, meaning that it is unsuccessful about 10% of the time because the surgeon was unable to locate the olive-sized tumor in the neck, or the operation was unsuccessful because the patient had two tumors and the surgeon removed only one.
Parathyroid surgery can be tricky and difficult for surgeons without lots of experience. Since parathyroid glands can be located in weird places (they are not always next to the thyroid where they are supposed to be), and because 30% of people with hyperparathyroidism have more than 1 parathyroid tumor, the experience of the surgeon is very important. In fact, it is well known that surgeon experience is very important for a good outcome, probably more so than for any other operation.
Fortunately, a number of advances have been made in the past 15 years that makes parathyroid surgery more successful, faster, and safer. Virtually all patients should have a mini-parathyroid surgery, and the old fashioned “exploration” surgery should be abandoned. When performed by an expert, parathyroid surgery can often be completed in under 20 minutes with the patient going home from the hospital an hour or two later. There is an excellent video of a mini-parathyroid operation in the video section of this app. One last point of caution, a mini-parathyroid operation does not mean that the surgeon operates through a small hole and removes the tumor and quits. Surgeons that evaluate only one parathyroid gland during the operation will have long-term cure rates less than 85 or 90%, meaning that 10-15% or more of these patients will require a second parathyroid operation. The highest cure rates can only be achieved if all four parathyroid glands are evaluated during surgery which can often be done very safely in less than 20 minutes by very experienced parathyroid surgeons. Another section discusses questions you should ask when interviewing a potential surgeon.
For more detailed information on this topic: http://www.parathyroid.com/treatment-surgery.htm