Partial thyroidectomy and parathyroid glands

[tcpace]

Anyone know whether surgeons try to preserve the parathyroid glands associated with the half-thyroid removed during a hemithyroidectomy? I would imagine that they're tricky to preserve so I wouldn't be surprised if they just whip them out along with the half-thyroid being removed.

[Haze1975]

I’d had my thyroid operation done in two half. Because They was trying to save it. But I was unlucky because when they tested the half the cancer had spread to the rest of it. So they had to go back in for the second part of the thyroid.

But it is in the hope that the second part of the thyroid can will still work

Good luck.

[Lalatoot]

The parathyroid glands lie behind the thyroid. That's what the name means. They are not involved in the production of thyroid hormones.They produce parathyroid hormone, which plays a role in regulating the body's blood level of calcium and phosphorus. These are important for proper muscle and nerve function and of course bones. So these glands need to be preserved if at all possible.

[tcpace in reply to Lalatoot]

I realise that they have nothing to do with the thyroid hormones. I was enquiring whether surgeons really do make the effort to preserve them given that they seem perfectly happy (at least in the UK) to remove half the thyroid to carry out a thyroid biopsy. In other words, they don't make any real effort (in the UK) to see how much of the affected half-thyroid can be preserved. Maybe I'm being cynical but I'm not sure how much I trust the medical profession these days.

[birkie in reply to tcpace]

During my TT I was informed that they make every effort to preserve the parathyroid glands, they would only remove them if one was buried deep with in the thyroid tissue and couldn't be located, or the surgeon saw it was enlarged, we all have 4 parathyroid glands and we can function well with only one, usually after thyroidectomy your given calcichews because during surgery the parathyroid glands can be bruised causing them to go dormant for a while (hypoparathyroid) , mine didn't mine went overactive (primary hyperparathyroidism) I now have this diagnosis.And I'm with you on trust, I've just found out I've got re- growth of thyroid tissue in my left thyroid bed and thyroglossal tract, I had graves thyrotoxicosis and were told all thyroid tissue was to be removed 🤷‍♀️

[jimh111]

Ask the surgeon. I believe they usually try to preserve them and may transplant them the neck or into an arm.

[Brightness14 in reply to jimh111]

Correct I had this done neck and arm four in total.

[jimh111 in reply to Brightness14]

So, if you loose an arm or get decapitated you will still be OK!

[Brightness14 in reply to jimh111]

I am so pleased to hear that I was beginning to worry.

[Hedgeree]

Hi tcpace,

I had a hemi thyroidectomy last year due to a thyroid lump with suspicious cells. Prior to surgery I did ask the surgeon about my parathyroid glands, she said that they will try to preserve them but they may get disturbed during surgery. After surgery I was told that I did still have all of them intact.

[tcpace in reply to Hedgeree]

Thanks for your comments Hedgeree. It was my wife who had the operation 14 years ago and she was told of the risk to the parathyroid glands. However, nothing was said afterwards and we didn't think to ask as we weren't aware at the time how the relevant they are to bone integrity. Fast forward to now and we're wondering whether they were preserved or not and, if not, whether their absence has contributed to my wife's osteoporosis and the fractured lumbar vertebrae she recently suffered after a fall. Apparently hypoparathyroidism can affect bone strength, not just hyperparathyroidism.

[Hedgeree in reply to tcpace]

You'd hope that a surgeon would try to ensure they were preserved. At least your wife was told that they could get damaged during surgery. I realise it was some time ago but would you be able to get in touch with the hospital where she had her operation in order for her to access her records to check? Not sure how easy that would be?

A few months ago I was diagnosed with osteoporosis of the lower spine after a DEXA scan. Not sure how long I've had it for but suspect it could have been for some time; I'd broken my arm fairly easily during lockdown. Also I've had a severe vitamin D deficiency and that's not helped my bone health. Now I'm being monitored for normocalcaemic hyperparathyroidism.

Best wishes for your wife's recovery.

[tcpace]

Thanks again Hedgeree. Not sure about asking the hospital about an operation conducted 14 years ago but will if it the bone consultant thinks it might be useful. Cheers for now and take care with those bones of yours!

[Poniesrfun in reply to tcpace]

Request a parathyroid level blood test (PTH). This will show if there are normally functioning parathyroids present.

Patti in AZ

[Didntexpectthis]

I think they would say if removed and calcium may have been needed for a while if they had removed them. I had a full thyroidectomy and they had 2 remove 2 of mine. I was in hospital for a week while my calcium levels were regulated and then was on calcium for 4 months.

I do think they try to preserve them as far as they possibly can.

[Brightness14]

A good experienced surgeon would always reposition these as a matter of course. You should ask him when meeting up before surgery.. Choose your thyroid surgeon carefully.

Here in France they only ever remove the whole thyroid, thus avoiding a second operation later on.

[Brightness14]

I forgot to say that after my TT my Calcium Test was done by a home nurse and the information was relayed to the surgeon, after about a week his secretary rang me telling me to stop the calcium as my levels were perfect again.

[annnsandell]

Surgeons will always try to preserve the parathyroid glands. I have a partial and full thyroidectomy and they were preserved. Your calcium levels should be tested after the operation. I hope it all goes well for you.

[gitbra]

Hæ there. Of course...they do. And since it can be tricky ( f.ex. the bloodvessels can be shared with the thyroid) it is important to have an experienced ( endokrine) surgeon. The risks of complications ( like removal of pthglands..recurrens paresis etc) is much lower then.

[Otto11]

I had a partial Thyroidectomy 28 years ago & as far as I know my Parathyroid glands are intact. I do have Osteopenia but think this is related more to my Rheumatoid Arthritis.

[Candyben]

I have a question, if any part of thyroid gland is left after surgery, is it possible for it to grow again ?

[helvella Administrator in reply to Candyben]

As I understand, new tissue can sometimes grow but it is likely not to be active, and will not be like a replacement thyroid. However, there have been a few reports of regrown tissue producing some thyroid hormone.

[birkie in reply to helvella]

Hi helvella.I had a US scan on my neck in Nov 2022 (privately) very good parathyroid surgeon in bambary, he located a nodule of 6/7mm on the left side but nothing else.

Fast forward to 2023 I have F18 pet scan to determine what the 6/7mm nodule is, I had an uptake on the right, a mass of (14 x 7 x21mm) FNA identified thyroid tissue, I had full thyroidectomy in 2019 due to graves thyrotoxicosis, both lobes lit up, oral iodine treatment before operation .

The uptake was the same as my thyroid scan, before thyroidectomy lit up the same, so if it lights up on the scan does that mean it's graves again?

This mass as grown in one year, surgeon says she'll do another scan in 6 months.

I did some digging, and yes your correct that the tissue can produce hormones although it's rare, the surgeon I saw is happy to leave this mass (14 x 7 x 21) in situ, I on the other hand are dubious as I'm having a lot of hyper symptoms and throbbing pain in that area for around 6 months, but we're told by endo it's because you've had thyroidectomy.

I've had it all over Christmas and yesterday was a killer, my voice as also gone back to when I was hyperthyroid (graves) like I've smoked all my life, never smoked 🤷‍♀️ everytime I speek to a friend who I've not see for a while they always say "ho dear have you got a sore throat" 🤦‍♀️ I even had a low hoarse voice when speeking to the endo on Dec 27th and I noted this, she didn't flinch😡.

I'm having real trouble with the thyroid medication to, hoping to get this resolved with another endocrinologist soon.

[helvella Administrator in reply to birkie]

People with rare versions of things often get poorly treated.

All the assumptions go towards the most common version/form and ignoring the outlier cases.

Hoping someone you see responds sensibly to you in the very near future.

[birkie in reply to helvella]

Hopefully helvella I can choose my own endo as this one just told me to find another one myself, very un professional of her😡

[looselywoven]

Hi

I had a hemithyroidectomy and partial parathyroidectomy several years ago. The parathyroid has worked fine ever since. There were lesions on the parathyroid but the remainder has been fine. I had an excellent surgeon.

[Litatamon]

Removing & then repositioning the parathyroid glands is the skill of a thyroidectomy. So yes surgeons work meticulously to do that. And then monitor levels coming out of surgery to make sure nothing went wrong. There can be damage, as patients should be told (I was) or at times just temporary trauma to them, that will work itself out in a timely manner. And of course, and most often, no issue at all.

I watched a thyroidectomy on YouTube the night before my surgery. It was absolutely fascinating. Mainly due to how crazy delicate & small the parathyroid glands are & how difficult removal looks.

I discussed with my surgeon post-op. She told me that is what takes the most time in a thyroidectomy, because it is such painstakingly delicate work.