The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Minimally invasive video-assisted parathyroidectomy in August 2014.


Hyperthyroidism causes symptoms such as anxiety, weight loss, breathlessness, tiredness, and eye problems. The overactive thyroid is usually enlarged and clearly visible (goitre). The most common cause of hyperthyroidism is Graves' Disease, an autoimmune disease where antibodies stimulate the thyroid cells to secrete excess thyroid hormone. Other causes include toxic adenoma and toxic multinodular goitre.
First line treatment for hyperthyroidism includes medication to reduce the production of thyroxine or radioiodine treatment. Radioiodine treatment involves taking a drink or a capsule that contains radioactive iodine. The radioactivity concentrates in the thyroid gland and destroys some of the thyroid tissue. Surgery to remove part or all of the thyroid gland is also an option.


Hyperparathyroidism occurs when an excess of parathyroid hormone is released by the parathyroid glands in the neck. It generally leads to high levels of calcium in the blood. Symptoms and signs include tiredness, depression, confusion, constipation, polydipsia, polyuria, the development of kidney stones, bone pain and fractures. The most common cause of primary hyperparathyroidism is a single adenoma. Other causes include hyperplasia affecting more than 1 parathyroid gland and rarely, cancer. Secondary hyperparathyroidism can also occur, resulting from conditions such as kidney disease, vitamin D deficiency and gut malabsorption.

Patients with mild hyperparathyroidism may not need active treatment, but will be regularly monitored. More severe hyperparathyroidism is usually treated by surgery to remove the abnormal parathyroid gland or glands.
Conventional open thyroidectomy or parathyroidectomy is done through an incision across the base of the neck. Endoscopic techniques have been developed that use smaller incisions, with the aim of reducing postoperative pain and improving cosmesis.

Coding recommendations

Minimally invasive video-assisted thyroidectomy:

B08.9 Unspecified excision of thyroid gland

(Other codes from B08 Excision of thyroid gland may be used instead, dependent upon the degree of the thyroid gland excision.)

Y76.3 Endoscopic approach to other body cavity

Minimally invasive video-assisted parathyroidectomy:

B14.9 Unspecified excision of parathyroid gland

(Other codes from B14 Excision of parathyroid gland may be used instead, dependent upon the degree of the parathyroid gland excision.)

Y76.3 Endoscopic approach to other body cavity

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)