Parathyroidectomy is the surgical removal of one or more parathyroid glands, to cure hyperparathyroidism.

The parathyroid glands are four rice-sized glands located on back of the thyroid gland in the neck. The parathyroid glands make parathyroid hormone (PTH), which controls the levels of calcium in the body

In patients with hyperparathyroidism, one or more parathyroid glands become enlarged and oversecrete parathyroid hormone, causing levels of calcium to rise in the blood

Surgery to remove the enlarged gland (or glands) is the only definitive treatment for the disorder and cures it in 95 percent of cases.

With the use of accurate preoperative imaging studies and intraoperative parathyroid hormone measurement, minimally invasive parathyroidectomy via a 2-3 centimeter incision is possible in the majority of cases.

In 85-90% of patients with primary hyperparathyroidism, only one gland is abnormal. This allows endocrine surgeons to perform a more limited, focused exploration where there is a high likelihood of having only a single abnormal gland.This approach is referred to as a “minimally invasive parathyroidectomy” or MIP and is the most common procedure performed by our surgeons. The MIP procedure has the following advantages for patients:

  • Less post-operative pain
  • Faster recovery from surgery
  • Small or barely visible scar
  • Shorter hospital stay
  • A more rapid return to work and normal activities

What are the risks of the operation?

There are three main risks for parathyroidectomy.

  1. Recurrent laryngeal nerve injury: This nerve controls your vocal cords and if injured you will have a hoarse voice. There is a 1% chance of permanent hoarseness and a 5% chance of temporary hoarseness  (<6 months).
  2. Low blood calcium: There are parathyroid glands that lie behind your thyroid gland that help to control your blood calcium levels. If they are injured or removed (can lie within the thyroid gland) during your operation, then your blood calcium can be too low. This would require you to take calcium and vitamin D supplementation. There is a 1% chance of permanent calcium supplementation and 5% chance of temporary calcium supplementation.
  3. Bleeding: There is a 1/300 risk of bleeding with your operation. This is the main reason you stay overnight in the hospital, if your surgeon recommends it.

 

How long is my hospital stay? Can I have someone stay with me overnight?

Most patients only spend one night in the hospital or may be discharged at the end of the surgery day depending on your case.

What kind of scar will I have after surgery?

The incision is about 1-2 inches in length, and is placed in the midline of the neck in a normal skin crease to minimize scarring and visibility.

How do I care for the incision?

There will be Steristrips or surgical glue on your incision. These can be removed 10-14 days following your operation. There is no need to place any further dressing on your incision. You may use vitamin E oil or similar product to help the healing process, but it is NOT necessary. You SHOULD use sunscreen and/or cover to protect the incision from the sun. You may take a shower. It is OK to get it slightly wet, but not soaking wet.

What medications will I be taking after my operation?

Your blood calcium will be checked the night of your operation and in the morning following your operation.  If your blood calcium level is low following your operation, you may experience hypocalcemia symptoms such as numbness/tingling and muscle cramping. These symptoms are relieved by taking calcium supplements, typically TUMS, and if needed, vitamin D (Rocaltrol).

If you have persistent tingling despite taking calcium as directed, you should call our office to let us know. Pain medication may be taken as necessary, and is usually only needed for three to four days following parathyroidectomy.

Are there any restrictions following my operation?

You can resume regular activity as tolerated. Walking outside, going up and down stairs, and performing light activities are all encouraged. Avoid strenuous activity or lifting anything that weighs 10 pounds or more until you feel up to it. If you are feeling well and are not taking any pain medication, you may drive (usually the third or fourth day after surgery).

 

References:

UCSF endocrine surgery