Parathyroidectomy is a specialised neck operation that removes one or more parathyroid glands when they become overactive, enlarged or abnormal. These tiny glands sit just behind the thyroid in the lower neck and they help regulate calcium in the bloodstream. When they are overactive, due to a benign tumour called a Parathyroid adenoma, calcium levels can rise, sometimes slowly over many years. This can affect bones, kidneys, nerves and muscles, and in rare cases may be related to a parathyroid tumour that needs cancer surgery as part of a broader head and neck treatment plan.
At Melbourne ENT in St Kilda East, patients having parathyroid surgery are cared for primarily by Dr Stephen Kleid, ENT and Head & Neck Surgeon (MBBS, FRACS). Dr Kleid is a specialist surgeon with decades of experience in complex neck operations and head and neck tumour surgery. He has trained and worked in major Melbourne hospitals and completed a fellowship in ENT and head and neck tumours at the University of Florida. His practice includes extensive work with thyroid and parotid tumours, throat and mouth cancers, and sleep apnoea, and this background informs his careful and methodical approach to parathyroid and neck cancer surgery.
Parathyroidectomy is a medical and functional procedure rather than a cosmetic operation. Its main goals are to improve or stabilise blood calcium and parathyroid hormone levels, protect long term bone and kidney health and, where needed, remove a tumour or suspicious gland as part of cancer surgery.
The information on this page is designed to help you understand the procedure, the reasons it might be recommended, and what to expect before and after surgery with Dr Stephen Kleid at Melbourne ENT. It does not replace individual medical advice and your own treatment plan should always be made in discussion with your GP, endocrinologist and surgeon.
What Is Parathyroidectomy?
Parathyroidectomy is an operation to remove abnormal parathyroid tissue. Most people have four parathyroid glands, each about the size of a grain of rice, which sit behind the thyroid gland. These glands produce parathyroid hormone, a substance that helps control how the body absorbs and stores calcium.
In conditions such as primary hyperparathyroidism, one or more glands produce too much hormone. Blood calcium levels then rise and can gradually cause problems with bone strength, kidney function and general wellbeing. Some patients have a single benign parathyroid adenoma, while others may have multiple enlarged glands or changes related to long standing kidney disease. In a smaller number of cases, there may be a parathyroid tumour, which can occasionally be cancerous and therefore treated using cancer surgery principles.
Parathyroidectomy involves carefully exposing the parathyroid region in the neck and removing whichever glands are diseased, while preserving healthy tissue and protecting nearby nerves and structures. For many patients the purpose of the operation is functional and metabolic, focusing on calcium control. When a tumour is present, especially if malignancy is suspected or confirmed, the operation may also have a strong cancer surgery component, aiming to remove the tumour safely and reduce the risk of local recurrence.
Who Needs Parathyroidectomy?
Patients are usually referred for a parathyroid surgery opinion after blood tests show persistent abnormalities, or when complications develop that are linked to high calcium. Often, your GP or endocrinologist will have already carried out several investigations before suggesting that you see a head and neck surgeon.
You may be considered for parathyroidectomy if you have a confirmed diagnosis of primary hyperparathyroidism with consistently raised calcium and parathyroid hormone levels. This is particularly the case if you are experiencing complications such as reduced bone density, osteoporosis, fractures, kidney stones or reduced kidney function. Some people have relatively few symptoms at the time of diagnosis but are at risk of longer term problems if the condition is left untreated.
Other patients have secondary or tertiary hyperparathyroidism related to chronic kidney disease. In these situations, medical therapies are usually tried first and surgery is considered when medical treatment cannot control the condition adequately or causes difficulties. A smaller group of patients may present with a neck lump, suspicious imaging finding or parathyroid lesion that raises concern for malignancy. In that situation, cancer surgery planning and long term follow up become especially important.
Not everyone with high calcium automatically needs an operation. Age, general health, the severity of biochemical changes, bone density measurements, kidney findings, symptoms and personal preferences all contribute to the decision. During a consultation, Dr Stephen Kleid reviews your results, listens to your experience of symptoms and discusses the balance between the potential benefits and risks of proceeding with surgery versus monitoring the condition.
Parathyroid Surgery Melbourne – What are the Benefits
The benefits of parathyroidectomy vary between individuals, but there are several potential advantages that are often discussed when considering surgery. From a functional and metabolic perspective, the procedure is intended to correct or improve the biochemical imbalance that underlies hyperparathyroidism. When abnormal glands are removed successfully, blood calcium and parathyroid hormone levels often move back toward a more normal range.
Over time, this can help reduce the risk of ongoing bone loss and may allow bone density to stabilise or improve. For patients who have already experienced fragility fractures, improving bone health becomes a key long term goal. Reducing calcium levels can also lower the chance of further kidney stones and may help protect kidney function. Some people notice changes in energy levels, concentration, mood or musculoskeletal discomfort after their calcium levels are better controlled, although the degree of improvement is individual and symptoms often have multiple contributing factors.
When parathyroidectomy is performed as part of cancer surgery, there is an additional set of benefits related to disease control. Surgical removal of a parathyroid carcinoma or a malignant neck tumour aims to clear the primary lesion and any involved surrounding tissue where appropriate. This may reduce the risk of local recurrence and help control severe hypercalcaemia that is sometimes associated with malignancy. In such cases, surgery fits into a broader plan that might include further imaging, long term surveillance and, in selected situations, additional treatments advised by the multidisciplinary team.
It is important to understand that parathyroidectomy is only one component of your overall management. After surgery, regular follow up with your endocrinologist and GP remains important. They will monitor your calcium and parathyroid hormone levels, arrange bone density scans at suitable intervals and advise on lifestyle and medical strategies to support bone and kidney health.
Consultation For Parathyroidectomy
A consultation with Dr Stephen Kleid is your opportunity to understand your diagnosis, explore the role of surgery and consider your options in a calm, informed way. The aim is to give you clear information and to support shared decision making rather than simply moving quickly to an operation.
The appointment usually begins with a detailed history. Dr Kleid will ask about your symptoms, even if they seem subtle or vague, and about any episodes of kidney stones, fractures, bone or joint pain, low mood, nausea or fatigue. He will also ask about medication use, past medical conditions, previous operations, any family history of endocrine or neck problems and any exposure to radiotherapy in the neck region. These details help identify patterns that may guide investigations and influence surgical planning.
He will then perform a careful head and neck examination. Although the parathyroid glands themselves are not usually palpable, the thyroid gland, lymph nodes and any neck masses are assessed. This is particularly important for patients who might have a coexisting thyroid nodule or other neck lesion that could affect the choice of operation or suggest a need for cancer surgery principles to be applied.
Existing investigations are reviewed in depth. These often include serial blood tests for calcium, parathyroid hormone, vitamin D and kidney function, bone density scans, and imaging such as neck ultrasound, nuclear medicine studies or CT scans. If any key information is missing, additional tests may be organised. Dr Kleid will explain the results in plain language, using diagrams or written notes if helpful, so that you can see how they relate to your condition.
Once the picture is clear, he will outline the treatment options. This may include monitoring without surgery in selected cases, continuing or adjusting medical therapy for complex endocrine or kidney disease, or proceeding with parathyroidectomy. If surgery is recommended, he will describe what the operation involves, whether the focus is mainly metabolic or whether cancer surgery considerations are also present, what the likely benefits and risks are in your situation, how long you can expect to stay in hospital and what sort of follow up will be arranged. You are encouraged to ask questions and to take time to think about your decision.
How Is Parathyroidectomy Performed?
Parathyroidectomy is generally performed under a full general anaesthetic. This means you are asleep, unaware and pain free during the procedure. The anaesthetist looks after your airway, breathing, circulation and comfort throughout the operation, and your medical history is reviewed beforehand so that any health issues can be managed safely.
On the day of surgery, you are admitted to the hospital and nursing staff carry out routine preoperative checks. Dr Stephen Kleid will see you before you go to theatre to confirm the plan, answer any last minute questions and obtain your final consent. In the operating theatre, monitoring devices are attached and a drip is placed in your arm. Once everything is ready, the anaesthetic is administered and you drift off to sleep.
A small incision is made low in the front of the neck, typically following a natural skin crease. The neck muscles are gently separated, not cut, to reach the thyroid and parathyroid area. The tissues are handled carefully to reduce bruising and swelling. Throughout the procedure, attention is paid to identifying and preserving the recurrent laryngeal nerves, which control the vocal cords, and to protecting important blood vessels and surrounding structures.
If preoperative imaging has clearly shown one abnormal gland, a focused parathyroidectomy may be possible, where the dissection is concentrated in that region. In other cases, a more extensive neck exploration is required in which all four parathyroid glands are examined to determine which are enlarged or overactive. Occasionally, tissue is sent for rapid pathological assessment during the operation to confirm its nature.
When malignancy is suspected or confirmed, the operation is planned using well established cancer surgery principles. This may involve removing the affected gland with a surrounding cuff of tissue, and less commonly, addressing involved lymph nodes or adjacent structures if there is local spread. The aim is to achieve effective disease control while preserving function as far as possible.
Once the planned parathyroid tissue has been removed and there is no further need for exploration, the wound is closed in layers. Fine sutures are used to close the skin and a small drain may sometimes be left in place for a short period to collect fluid or blood. A dressing is applied over the incision. You are then moved to the recovery area as you wake up from the anaesthetic.
Recovery After Parathyroidectomy
Recovery after parathyroidectomy is influenced by your general health, the complexity of the surgery, and whether other procedures were done at the same time. However, there are some common stages that many patients experience.
Immediately after the operation, you will wake up in a recovery room where nurses and the anaesthetist monitor you closely. It is normal to feel drowsy, a little disorientated and mildly sore around the neck. Once your observations are stable and you are fully awake, you are transferred to a ward bed. Most patients can take sips of water fairly soon after waking and may manage a light meal later the same day or the next morning, depending on how they feel.
The neck incision usually feels tight, bruised or slightly swollen in the first few days. This is generally managed with simple pain relief tablets, although stronger medicines can be used for a short time if needed. Many patients notice some stiffness in turning the head, which gradually eases as they move more and the tissues heal. It is common to be encouraged to walk around gently in the ward to maintain circulation and reduce the risk of clots.
Calcium and parathyroid hormone levels are checked after surgery. Because the body suddenly has less parathyroid hormone than it is used to, calcium levels can fall. Some people notice tingling around the mouth or in the fingers, or cramping in the hands or feet, which can be a sign of low calcium. These symptoms should always be reported promptly. They are usually managed with calcium and sometimes vitamin D supplements. In many cases, the remaining glands adjust over time and supplementation can be reduced or stopped, but this varies between individuals.
Most patients remain in hospital for at least one night. The length of stay can be a little longer for more complex operations, for patients with significant medical conditions or where cancer surgery has required a wider dissection. Once you are eating, drinking, mobilising safely, and blood tests are acceptable, discharge can be arranged. You go home with clear written instructions about wound care, medications, activity levels and warning signs that should prompt review.
At home, it is wise to plan a quiet period of recovery. Tiredness is common and it can take a week or two to feel fully back to normal. Gentle daily walking is usually encouraged. Heavy lifting, strenuous exercise and vigorous neck extension are avoided until your surgeon advises that it is safe to resume them. Most people in office based work return after about one to two weeks, although this is flexible. Those in physically demanding jobs may need a longer period off.
Follow up appointments are arranged to check the incision, remove any non dissolving sutures if used, review the final pathology report and repeat blood tests. Longer term follow up with your endocrinologist and GP will focus on monitoring calcium and parathyroid hormone levels, bone density, kidney function and overall wellbeing, and on making any necessary adjustments to medication or supplements.
Risks And Complications Of Parathyroidectomy
Even with careful planning and experienced surgical technique, all operations carry risks. A thorough discussion of these risks is part of responsible practice, especially in head and neck and cancer surgery.
General risks associated with surgery and anaesthesia include bleeding, wound infection, blood clots in the legs or lungs, and reactions to anaesthetic drugs. People with underlying heart, lung or other medical conditions may be at higher baseline risk for complications and this is taken into account when planning surgery. The anaesthetist and the surgical team will assess you beforehand and may request additional tests if needed.
Specific to parathyroidectomy, one of the most important issues is the risk of low calcium after surgery. Temporary hypocalcaemia is fairly common, particularly if more than one gland has been removed or if the remaining glands have been suppressed for a long time. Symptoms may include tingling, cramps, twitching or, in more severe cases, more generalised symptoms that require urgent attention. This is why calcium levels are monitored closely after surgery, and why some patients go home with calcium and vitamin D supplements for a period. In a smaller proportion of patients, calcium levels remain low in the longer term and ongoing medication and monitoring may be required.
Another key risk involves the recurrent laryngeal nerves, which lie close to the thyroid and parathyroid glands. These nerves control the vocal cords. If they are bruised or stretched during surgery, the voice may be hoarse, breathy or weaker for a period. In many cases this improves over weeks or months. Permanent nerve injury is less common but can cause lasting changes to voice quality or, rarely, breathing. Patients who use their voice professionally, such as teachers, singers or public speakers, are often particularly concerned about this possibility. If issues occur, referral to a speech pathologist and, in selected cases, further procedures may be considered.
Other possible complications include neck haematoma, which is a collection of blood under the skin, swallowing discomfort, temporary numbness around the incision and variations in scar appearance. A neck haematoma that causes pressure on the airway is a rare but serious complication that requires urgent management, which is one of the reasons why close early observation in hospital is important. Scars generally mature over several months and measures such as sun protection and gentle massage may be recommended to support favourable scar development.
When parathyroidectomy is performed as cancer surgery, the extent of dissection may be greater, particularly if involved lymph nodes or surrounding tissues need to be addressed. This can increase operative time and may be associated with a slightly different risk profile. These factors are weighed carefully against the need to manage the cancer appropriately and are discussed individually with each patient.
Cost Of Parathyroidectomy
The cost of parathyroidectomy at a private hospital in Melbourne depends on several factors. These include the complexity of the operation, whether a focused or more extensive neck and cancer surgery approach is required, the hospital where the procedure is performed, the expected length of stay, and the involvement of other specialists such as the anaesthetist and any physicians who may assist with perioperative care.
Because parathyroidectomy is undertaken to treat a medical condition, and in some cases to treat or investigate possible cancer, Medicare item numbers usually apply. These can offset part of the surgeon and anaesthetist fees. If you have appropriate private health insurance, your fund may cover some or all of the hospital and theatre expenses, subject to any excess or co payment specified in your policy. There may still be a gap between the scheduled Medicare fee and the total fee charged.
Every case is different, so it is not possible to give a meaningful figure without first understanding your individual situation and the likely procedure. After you have seen Dr Stephen Kleid and a surgical plan has been proposed, the Melbourne ENT team can provide a tailored estimate. This will outline the surgeon and anaesthetist fees, the Medicare rebate, any expected out of pocket amount and general information about hospital billing. You can then forward this information to your health fund and ask them to confirm how your policy will respond.
For general guidance about fees and payment processes, you can also refer to the costs or fees information on the Melbourne ENT website or discuss questions with the practice staff.
Medicare Coverage And Insurance
In Australia, parathyroidectomy and related endocrine neck procedures are considered medically necessary interventions rather than cosmetic surgery. As a result, they are usually associated with Medicare item numbers that attract a rebate. This applies whether the primary goal is to treat hyperparathyroidism or to remove a tumour as part of cancer surgery.
If you hold private hospital insurance, your fund may cover some or all of the hospital account, including operating theatre and accommodation charges, depending on your level of cover, waiting periods and any exclusions or restrictions. You will usually be responsible for any policy excess and for any difference between what your fund pays and the amounts charged by the hospital. Surgeon and anaesthetist fees are partly rebated by Medicare and your fund, but there may be a gap that you pay personally.
Before committing to surgery, it is helpful to contact your health fund with the item numbers and hospital details provided by Melbourne ENT. You can then ask for specific information about what is covered, what your excess will be and whether any co payments or restrictions apply. Patients without private insurance may still explore options for self funded surgery in the private system or access to public hospitals, depending on their clinical situation and local pathways.
The Melbourne ENT team is accustomed to helping patients navigate these questions and can guide you on how to obtain clear answers from your insurer and from the hospital billing department.
Why Choose Your Surgeon
Choosing a surgeon for a neck or cancer related procedure is a significant decision. Patients often look for a combination of formal qualifications, specific experience in the relevant area and a communication style that makes them feel heard and informed.
Dr Stephen Kleid is an ENT and Head & Neck Surgeon with extensive training and experience in complex neck surgery. He graduated in medicine from the University of Melbourne and completed his surgical training through major Melbourne teaching hospitals, including Royal Melbourne Hospital, The Royal Children’s Hospital, The Royal Victorian Eye and Ear Hospital and St Vincent’s Hospital. He then undertook a fellowship in ENT and head and neck tumours at the University of Florida, where he gained advanced experience in the surgical management of cancers and other serious conditions affecting the head and neck.
Over many years as a senior surgeon, Dr Kleid has been heavily involved in the management of throat and mouth cancers, thyroid and parotid tumours, sleep apnoea surgery and other complex head and neck conditions. He has contributed to research in several of these areas and has also been active in teaching medical students and surgical trainees. This background means he brings a thoughtful, evidence based approach to parathyroidectomy and other endocrine neck operations.
At Melbourne ENT, the focus is on careful assessment, clear explanation and shared decision making. Parathyroidectomy or cancer surgery is recommended only when it is likely to offer meaningful benefit in the context of your overall health and personal priorities. Detailed preoperative discussions, written information and structured follow up appointments are designed to help you understand each step of the process and to feel supported from referral through to long term review.
FAQs About Parathyroidectomy
Can I still safely have parathyroidectomy if I have already had previous surgery or radiation treatment to my neck?
Previous surgery or radiation in the neck can make dissection more technically challenging because normal tissue planes may be altered and there may be more scarring or fibrotic tissue. This does not automatically mean that parathyroidectomy is unsafe or impossible, but it does require particularly careful planning and an honest discussion about the potential risks and benefits. In many cases, surgeons with head and neck and cancer surgery experience are accustomed to operating in previously treated necks and will adapt their approach accordingly. Imaging, prior operative reports and sometimes additional specialist input can all assist in determining whether surgery is appropriate and, if so, how best to carry it out.
How might parathyroidectomy affect my voice if I rely on it professionally, such as for teaching, singing or public speaking?
Because the recurrent laryngeal nerves that control the vocal cords run close to the thyroid and parathyroid glands, any surgery in this area carries a small risk of voice change. For people whose work depends heavily on their voice, even subtle changes can feel significant. Before surgery, Dr Stephen Kleid will discuss this risk explicitly, especially if you are a professional voice user. The operation is planned to minimise nerve disturbance, but it is important to understand that temporary hoarseness or weakness can still occur. If you notice persistent changes after surgery, assessment by an ear, nose and throat specialist and a speech pathologist can help clarify what is happening and what strategies or therapies might improve voice function.
What happens if my calcium and parathyroid hormone levels improve on medication before surgery, do I still need the operation?
In some situations, particularly in secondary hyperparathyroidism, medications such as vitamin D, calcium modifying drugs or treatments for kidney disease can improve blood test results. When this occurs, it can be tempting to assume that surgery is no longer necessary. In reality, the decision to proceed with or postpone parathyroidectomy depends on the underlying cause of the problem, how stable your results are, how well you tolerate the medication and whether complications such as bone loss or kidney damage are still present or likely. In your consultation, Dr Kleid will review the pattern of your test results over time and talk through whether surgery remains advisable or whether continued medical management and observation is a reasonable option.
If a parathyroid tumour turns out to be cancer, how does that change my long term follow up and the type of scans or tests I might need?
Parathyroid carcinoma is rare, but when it is diagnosed, the follow up plan becomes more focused on cancer surveillance in addition to monitoring calcium and parathyroid hormone levels. You may require more frequent clinical reviews, regular blood tests and periodic imaging of the neck or other regions to look for signs of recurrence or spread. Long term follow up is particularly important because parathyroid cancer can recur years after initial treatment. Dr Stephen Kleid will usually coordinate this care with your endocrinologist and, where appropriate, with a multidisciplinary cancer team so that imaging, blood tests and clinical assessments are scheduled in a structured and coordinated way.
Can parathyroidectomy influence future pregnancy plans, fertility treatments or the way my calcium levels are managed during pregnancy?
Calcium balance is important in pregnancy for both the mother and the developing baby. Uncontrolled hyperparathyroidism can sometimes complicate pregnancy, so it is often preferable to manage significant parathyroid disease before conception if possible. If you are planning a pregnancy or undergoing fertility treatment, it is important to raise this with your GP, endocrinologist and surgeon. In some cases, parathyroidectomy before pregnancy can simplify calcium management later, but the timing has to be considered in light of your overall health and personal plans. After surgery, calcium and vitamin D levels may need to be monitored more closely in pregnancy and adjustments to supplements may be made in collaboration with your obstetric and endocrine teams.
How does parathyroidectomy fit in when I also have thyroid nodules or other endocrine problems that might need surgery in the future?
Many patients with parathyroid disease also have thyroid nodules or other endocrine conditions such as thyroid dysfunction, adrenal problems or genetic syndromes affecting multiple glands. When more than one glandular condition is present, it is important to consider the overall pattern rather than treating each problem in isolation. Sometimes parathyroidectomy can be combined with thyroid surgery in a single operation, while in other cases procedures are best staged. During your assessment, Dr Kleid will look at the broader endocrine picture and, in consultation with your endocrinologist, help plan a sequence of investigations and treatments that makes sense for your specific situation.
What kind of lifestyle changes, such as exercise, diet or bone health strategies, are realistically helpful after parathyroidectomy to support my long term results?
Surgery can correct a major driver of high calcium, but long term bone and kidney health also depend on everyday habits and other medical conditions. After parathyroidectomy, many patients are encouraged to follow general bone friendly strategies such as maintaining adequate dietary calcium, optimising vitamin D, engaging in regular weight bearing exercise, avoiding smoking and moderating alcohol intake. Your endocrinologist may also consider medications that strengthen bone if you have significant osteoporosis or fracture risk. Kidney health can be supported through good hydration and management of other conditions such as high blood pressure and diabetes where present. These measures do not replace surgery when it is clearly indicated, but they can complement the surgical result and help maintain the benefits over time.
Book A Consultation
If you have been told that you have high calcium, hyperparathyroidism, a parathyroid adenoma or a possible parathyroid tumour, or if your endocrinologist has suggested that parathyroidectomy or related cancer surgery might be appropriate, you are welcome to arrange a consultation with Dr Stephen Kleid at Melbourne ENT in St Kilda East, Victoria.
A referral from your GP or another specialist is usually required so that Medicare rebates can apply and so that your wider medical history is available for review. When you book, the reception team can advise you on what to bring, such as copies of blood tests, bone density scans, imaging discs and letters from other doctors.
To make an appointment, please contact Melbourne ENT using the details provided on the clinic website or by phoning the rooms during business hours. The team will help you find a suitable consultation time and can answer general questions about the process of seeing Dr Kleid.
This page is intended as a general guide for patients in Melbourne and regional Victoria who are seeking information about parathyroidectomy and related neck and cancer surgery. It does not replace personalised medical advice. For recommendations specific to your circumstances, please discuss your situation with your GP, your endocrinologist or contact Melbourne ENT to arrange a specialist review with Dr Stephen Kleid.
