Parathyroid Glands

Abstract

In patients with hyperparathyroidism, one or more parathyroid glands are surgically removed (parathyroidectomy). The only permanent cure for primary hyperparathyroidism, a disorder in which the parathyroid glands overproduce parathyroid hormone (PTH), is this procedure. A single parathyroid adenoma is present in the majority of people with primary hyperparathyroidism, but in a small percentage of cases, all four glands may be hyperplastic or there may be two adenomas. The conventional parathyroidectomy procedure entails examination of all four glands and removal of the adenoma in accordance with gland size. However, some surgeons have used minimally invasive surgery and quick intraoperative PTH monitoring to avoid examining all glands since the emergence of preoperative localization procedures, including radio-guided surgery, ultrasound (US) imaging, and high-resolution endoscopic techniques. The four tiny parathyroid glands, which are situated behind the thyroid gland, control the body’s calcium levels by secreting PTH. The inferior parathyroid glands are often found below the thyroid gland and in front of the recurrent laryngeal nerve, while the superior parathyroid glands are typically found behind the recurrent laryngeal nerve. These glands can occasionally be found in unexpected places, such as the mediastinum, thymus, carotid sheath, lower neck, thyroid gland, and retro-esophageal region. The inferior thyroid artery and, in certain situations, the superior thyroid artery supply the parathyroid glands. When the amount of serum calcium drops, the parathyroid glands’ main cells release PTH, which boosts calcium absorption in the kidney, encourages the conversion of 25-hydroxyvitamin D into active 1,25-dihydroxyvitamin D3, activates osteoclast activity in the bone, and raises serum calcium levels. Activated vitamin D levels rise in the intestines.