Reason for Parathyroidectomy

Parathyroid glands are four small glands located behind your thyroid gland in the neck. They produce parathyroid hormones (PTH), which controls your calcium in your body. In patients with hyperparathyroidism, one or more parathyroid glands become enlarged & abnormal, and overproduce PTH. If left untreated, this can lead to complications such as worsening osteoporosis, fractures and ureteric stones.

The purpose of parathyroid surgery is to locate and remove the abnormal parathyroid gland(s) and reduce the risks of these complications from occurring.

When performed by an experienced surgeon, the operation is successful in correcting the parathyroid hormone level in approximately 95% of cases. Complications can occur, but are uncommon. Depending on the calcium level after surgery, hospital stay may range from 1 to 3 nights. Your surgeon will explain your specific surgery and why it is recommended in your specific case.

Before the Surgery

Once you have gotten your surgery date, you will be scheduled for a pre-operative assessment. The preoperative exam may include blood tests, chest Xray and an electrocardiogram (ECG). If you are on anti-platelet medication such as aspirin or Plavix, or anticoagulation medication such as warfarin, you should stop your medication as instructed by your surgeon. Follow the instructions on when to stop eating and drinking given to you during the preoperative evaluation clinic assessment .

What happens during & immediately after Surgery?

During your surgery, you will be given general anaesthesia to put you to sleep. You are positioned appropriately with your head slightly tilted back. An incision is made at the base of your neck and is about 3-6cm long, depending on the exact type of operation you have. The surgeon locates the parathyroid glands and the abnormal one(s) are removed. The incision is then stitched closed.

Depending on your underlying condition, you may need to also have a central venous line  ( a line inserted into one of the big veins in your neck) inserted during the surgery for intravenous calcium replacement in the ward.
The operation generally lasts from 1 to 3 hours. After surgery, you will stay in the recovery room for a few hours. Once you are ready, you will be transferred to your ward for close monitoring after surgery.

What are the risks of surgery?

In experienced hands, parathyroid surgery is usually very safe and complications are uncommon. Some of the more serious possible risks of thyroid surgery include:

1. Bleeding- this can happen after surgery and this rarely can be life-threatening from airway compromise.

2. Low calcium levels: Parathyroid surgery may lead to low calcium levels after surgery. Patients may develop numbness and cramps of their hands and may need to take calcium and vitamin D supplements to prevent this from occurring.

3. Voice changes: Injury to the nerves that supply the muscles that move your vocal cords (recurrent laryngeal nerves) that can cause temporary or permanent hoarseness or possibly even acute respiratory distress in the very rare event that both nerves are injured.

4. Swallowing difficulties: Difficulty swallowing may occur due to tissue scarring or nerve injury.

5. Bad scarring. The majority of incisions in the neck heal well, but a few people are more predisposed to having thick and ugly scars (hypertrophic scars). Your doctor will advise you on how to take care of your incision after your surgery to minimize the risk of this happening.

How should I take care of my surgical wound after discharge?

• Wound Care
It is alright to shower with soap and water but avoid scrubbing or excessive pressure over your surgical wound in your neck. After showering, pat the wound dry gently with a towel but do not rub the wound forcefully.
Avoid immersing the wound in water until fully healed (e.g. swimming, soaking in a bathtub).
Avoid scratching of the wound, even if the wound becomes itchy.
Avoid smoking as this is bad for wound healing. There is no need to take any special diet or avoid any particular foods unless this has been specifically instructed by your doctor.

• Physical Activity
Avoid strenuous exercise or carrying heavy loads (>10kg) for the first week after surgery.
Standing and walking is alright.
Check with your doctor when it is okay to restart strenuous exercise.

• Pain medication
Your doctor will usually prescribe you some medication to help with any pain you might have after the surgery. Take your medication as advised by your doctor. If you continue to have significant pain despite taking the medication, let your doctor or nurse know.

When to seek consultation after discharge:

Seek medical attention immediately  if you have any of the following:
- Fever (Temperature > 38 C)
- Increase redness and pain over your neck wound
- Yellowish, foul-smelling discharge from the wound.
- The surgical wound starts to open up.
- Sudden swelling in the neck
- Difficulty breathing.
- Numbness or cramps in your hands or face.

Hypocalcemia (Low Calcium Levels)
Your doctor may have started you on some oral calcium tablets and vitamin D (calcitriol tablets) after your parathyroid surgery. Please remember to take them regularly as instructed by your doctor.

At home, if you experience increasing numbness of your hands or around your mouth, or have cramps in your hand, this may be a sign that your calcium levels are too low despite the medications. If this occurs, take an extra dose of your calcium tablets and seek medical attention immediately.

Who to contact for information after discharge: 

If you need to clarify on any of the above conditions, you can contact:
Your ward nurse clinician or
Make appointment with the Head & Neck Centre to see your physician earlier