
problems of disease of
parathyroid glands
if biochemical tests indicate unequivocally
that there is a functioning parathyroid tumour,
usually an adenoma, its removal will relieve
symptoms and prevent any further damage to
organs such as the kidneys.  in 80 per cent,
of such cases the operation is not particularly
difficult to anyone with experience of thyroid
surgery.  the tumour is seldom of great size,
usually less than half an inch in diameter, but
a careful search in the expected position, in
close apposition to the posterior surface of the
thyroid lobes, will usually reveal it.  such
adenomata are usually more brown in colour
than the normal yellow gland; but in some 20
per cent, of cases one or more of the glands
may be aberrant, or possibly absent, and super-
numerary glands may be present.  it is usually
one of the lower pair of glands which occupies
an ectopic position and, as i explained in the
outline of the embryological development, it
may accompany the thymus into the mediasti-
num, rather a vast area in which to seek a small
tumour.  such an exploration cannot be lightly
undertaken, but if the evidence is indisputable
the burden must be shouldered.  it is correct
policy, i believe, first to carry out a thorough
exploration of the neck, and if this proves un-
availing, to inspect the mediastinum through a
sternum-splitting incision some two weeks later,
rather than completing this major undertaking
at one session.
