Parathyroidectomy

What is Parathyroidectomy?

Parathyroidectomy is a surgical procedure that involves the removal of a single or multiple parathyroid glands (which produce hormones that increase levels of calcium in the blood).

There are four parathyroid glands (two on each side of the neck), however usually when hyperparathyroidism occurs only one is responsible for the imbalances in hormone levels

Indications for Parathyroidectomy

The treatment is indicated for patients with hyperparathyroidism (high levels of parathyroid hormone caused by a non-cancerous tumour).

Preparing for the Surgery

Before surgery, you will receive a complete medical evaluation and your doctor will discuss your surgery in detail.
The anaesthetist attending the procedure will also evaluate you. You should notify your doctor of any allergies or any medications you are taking.
You may be instructed to stop taking certain medications prior to surgery.
Nasoendoscopy is usually performed to check your vocal cords and their function.

Surgical Procedure

The type of surgery depends on the type of parathyroid problem and the results of imaging investigations pre-operatively. Imaging aims to identify the location of the tumour prior to the operation. This is not always possible.

Parathyroidectomy is performed under general anaesthesia. Depending on preoperative localisation and the nature of the disease the incision will be between 2 to 5 centimetre front of your neck. There are two approaches to surgery

Minimally invasive parathyroidectomy: for patients with a single abnormal parathyroid gland that has been identified on imaging this is the approach of choice. It allows exploration of one side of the neck through a smaller incision than is conventionally used.

Gland exploration is the traditional approach to parathyroid surgery that involves a larger incision to allow exploration of both sides of the neck. This is indicated in patients who have hyperparathyroidism without an abnormal gland identified on imaging. It is also used if there is co-existing thyroid disease, in patients with hyperparathyroidism due to renal failure and patients with hereditary parathyroid diseases.

The abnormal gland (tumour) is identified and removed carefully. Sometimes more than one abnormal gland is removed. If all four glands are removed, a part of one of the glands may be implanted in the forearm or the sternocleidomastoid muscle in the neck so that its function is not completely lost.

After removal of the tissue, the incisions are then closed with absorbable hidden sutures and waterproof glue.

Risks and Complications

Like all surgeries, parathyroidectomy may involve complications. Complications from parathyroidectomy are rare but include;

Bleeding
Infection
Hypocalcaemia ( low calcium levels)
Damage to nerves supplying vocal cords ( rare)
Recurrent or persistent hyperparathyroidism

After Parathyroid Surgery

Patients are admitted to the ward and monitored carefully overnight. Usually you are able to be discharged from the hospital the following morning.

Blood tests are undertaken during your admission to ensure your calcium levels are normal or returning to normal. Occasionally they can temporarily be low and medication required to supplement calcium.

Once the tumour is removed parathyroid hormone levels quickly return to normal. This is confirmed on blood tests and the pathologist examining the specimen.

Before leaving the hospital, you will be taught how to care for your incision and advised on how to minimise scarring.

Emergencies

Emergency Department - if you have a fever, shortness of breath, difficulty breathing, numbness or tingling in your fingers, hands, or mouth, muscle spasms, or if you notice signs of wound infection (redness, tenderness around the incision).

Pain Management

A prescription for mild pain medication will be given to you. You are not required to take it. If you do take it, please do not drive or drink alcohol as these in combination may make you drowsy. Most patients do not need strong pain medicine by the time they leave the hospital.
Numbness of the skin under the chin or above the incision is normal and should go away in a few weeks.

Post Operative Follow Up

Follow up is normally scheduled at 2 weeks following surgery in the office.
Your voice may be hoarse or weak. Pitch or tone may change. You may have difficulty singing. This usually goes back to normal over 6 weeks to 6 months.

Medication Management

A temporary drop in your calcium may occur after surgery requiring calcium medication on discharge. Blood tests will be used to guide this medication which is normally stopped after 3-4 weeks

Activity

Patients are able to return to full-time work within 1-2 weeks, however, this may vary according to your job.
Do not drive a car until you no longer taking stronger pain relief and able to turn the neck side to side (to check your blind spot). This is usually within one week.

Diet

You may have temporary throat discomfort or difficulty swallowing. This is due to the surgery around your larynx (voice box) and oesophagus (swallowing tube). These symptoms will gradually improve over the course of several weeks.
You may be able to return to your usual diet in a couple of days.

Wound Care

A waterproof glue is used as the dressing. Do not pick at the glue film following surgery. It will fall off within 2 weeks
You may shower after surgery but please do not swim or soak in a tub for at least 2 weeks. After you are done showering, just pat your incision dry.
Use sunscreen or wear a scarf for protection if in the sun for the first 6 months to a year as the sun can darken your scar.
Your incision may feel itchy while it heals. Avoid rubbing or scratching if possible.
You may begin to use a moisturizing cream or oil (Bio-Oil or Vitamin E cream) along the incision after 2 weeks