Parathyroidectomy - Dr Bridget Clancy

Fast Facts

Stop aspirin and other medications causing bleeding one week before surgery.

If you notice swelling in the wound or trouble breathing after surgery tell the nurse immediately.

There’s a small risk of permanent change in voice.

Take two weeks off to recover.

What is this for? Is it effective?

Parathyroidectomy means removing one or more of the parathyroid glands.

There are 4 parathyroid glands, two on each side of the neck, close to the thyroid gland and trachea/windpipe. They are small, around 5x7mm each.

Parathyroid glands make parathyroid hormone (PTH). This hormone is essential for short and long term calcium balance in the blood and bones. A normal level of calcium is necessary for nerves, the heart, the gut, the kidneys and bones to function normally. A high PTH level can cause a high calcium level, affecting kidney function and bone strength and causing fatigue and aches/pains. A low PTH level can cause a low calcium level, causing pins and needles sensation, muscle cramps/spasms, irregular heart beat and seizures.

The parathyroid gland or glands may need to be removed if they become overactive, making too much PTH and causing high calcium levels. This can be due to a single overactive gland (parathyroid adenoma or tumour) or all glands being overactive (4 gland hypertrophy). Parathyroid adenoma/tumour are almost always benign.

Tests for parathyroid disease:

Blood test for PTH, calcium and kidney function
Ultrasound shows the size and shape of the thyroid gland. Healthy parathyroid glands are usually too small to be seen on ultrasound. A large or overactive parathyroid gland may be picked up on ultrasound.
Sestamibi scan can detect an overactive parathyroid gland
4D CT of the neck and chest can detect the precise location of an overactive gland.
DEXA scan to look for bone health (osteopenia and osteoporosis).

Surgery to remove a single parathyroid adenoma has a very high rate of permanent cure. Surgery for 4 gland hypertrophy is more challenging and 1:10 people may need more surgery if the PTH level remains high.

Frequently Asked Questions

What could go wrong? Is there a chance that surgery could make me worse?

There are 2 structures close to the parathyroid glands that can be affected by surgery:

Blood vessels,
Nerves to the voice box (larynx). Damage can cause voice change.

Temporary side effects:

less than 1:100 people have bleeding into the wound requiring urgent care within a day of surgery. The thyroid and parathyroid glands have lots of blood vessels around them, that are sealed during surgery. In the first 24 hours after surgery, one of these blood vessels can bleed, causing sudden swelling in the neck and pressure on breathing. If this happens, you will be taken back to the operating theatre to have the blood vessel sealed again. The nurses will carefully watch for this complication after surgery. Tell the nurse straight away if you notice swelling in the neck.
2:100 people have temporary change in voice that can last up to 3 months.
Less than 1:100 people have an infection in the wound and need tablet antibiotics
Clots in the legs (deep vein thrombosis DVT) occur rarely with operations lasting longer than 45 minutes. Prevention starts in hospital with TED stockings, compression devices on the calves and injections of medication to prevent clots.
rarely, there can be low calcium for 1-2 weeks after surgery. This is treated with calcium and vitamin D tablets until it comes back to normal.
Very rarely, if both vocal cords are weak, breathing is difficult and a breathing tube inserted through the skin of the neck is required.

Permanent side effects:

Less than 1:100 people have permanent change in voice. There are procedures to help the voice sound stronger but they don’t make the voice sound perfect.
very rarely, PTH and calcium levels remain low after surgery and calcium and vitamin D supplements are taken daily in the long term.

Could I need more surgery or treatment in the future?

What are the alternatives to surgery? Are they appropriate for me?

There are 2 options for treatment: non-surgical or surgical.

Surgical treatment is recommended for people under 50 years of age with high PTH and for people over 50 years of age with a complication like kidney stones, impaired kidney function, aches/pains/fatigue or osteopenia/osteoporosis. Surgical treatment cures the problem in most people.

Non-surgical treatment is recommended for people over 50 years of age with mildly increased calcium level and no complication, or if there are other health problems making surgery more risky. Non-surgical treatment includes drinking extra water, having blood tests every 3 months and for some people, medication to reduce calcium levels. Non-medical treatment does not cure the problem.

What if I choose not to have surgery?

For mild disease without complications, it may be ok not to have surgery. You would still need to have blood tests every 3 months, if you choose not to have surgery.

See should I have surgery for more information.

How should I prepare for surgery?

Stop using any supplements and medications that increase bleeding (like Nurofen) one week before surgery and follow the fasting instructions provided by the hospital. Stop smoking for as long as possible before surgery.

See preparing for surgery for more information.

When will I come into hospital? How long will the operation take? How long will I stay in hospital?

You will come into hospital on the day of surgery. The operation takes 1-3 hours depending on the size and location of the gland.

You’ll go home the next day.

How long will I need off work/school/sport?

Don’t drive, operate dangerous machinery or make major decisions for at least 24 hours after an anaesthetic.

Take two weeks off work, sport and study.

Will I be awake or asleep for the operation? What kind of anaesthetic will I have?

Children and adults always have a general anaesthetic for this procedure.

See anaesthesia for more information.

How will I feel after surgery?

You will have mild pain in the wound. Most people need paracetamol only a few times in the first day after surgery and occasionally a stronger pain reliever. There are dissolvable stitches in the wound in the neck with a white steristrip dressing across the wound.

You will be eating, drinking and walking around normally within 4 hours of the procedure.

1:30 people feel sick or vomit after surgery.

Many patients tell me they feel tired for a few weeks after surgery.

What do I need to do to recover well?

Keep the wound dry and the dressing intact for a week. Don’t rub or apply heat packs. Eat as well as possible to aid healing. Avoid smoking.

Scar massage can improve the cosmetic appearance of the scar. You can start two weeks after surgery and continue every day for up to 6 months. Watch the video on how to do scar massage

When will I see the surgeon?

The surgeon will check on you in the recovery room, on the ward the next day and every day you are in hospital. You’ll have a bedside endoscopy the day after surgery or at the first post op visit, to check the vocal cords and voice.

The surgeon will see you again in the office one week and six weeks after surgery. You will have a blood test to check the PTH and calcium levels the day after surgery and six weeks after surgery.

What should I do if I need help or advice?

You can ring the surgeon or practice nurse during business hours on 55605411. For non advice outside business hours, ring the nurse at the hospital where you had surgery. For urgent care outside business hours, attend your nearest emergency department.

Click here for information about Dr Clancy’s on call schedule.

Is there any more information specific to my situation?

Your surgeon will take into consideration your work, sports/hobbies, support at home and other health problems as well as past reactions or complications with anaesthesia and surgery.

Your surgeon will answer any specific questions you ask.

After parathyroid surgery

You need 24 hours off driving after a general anaesthetic. You shouldn’t drive on any day when you have taken strong pain relievers or when you don’t feel capable of safe driving. Most people take 2 weeks off work and sport to recover after thyroid surgery.

What do I need to do to recover well?

The better you eat, the better you heal, especially fruit and vegetables. Keep the wound dry and the dressing intact until you see the surgeon in one week. Avoid vigorous activity (running, gym, competitive sports) and aim for some exercise like walking on most days.

Scar massage can improve the cosmetic appearance of the scar. You can start two weeks after surgery and continue every day for up to 6 months. Watch the video on how to do scar massage.

What is normal? How will I feel after surgery?

It is common to feel sore on the inside of the throat, due to the breathing tube used during surgery. The wound will be mildly painful. You may feel fatigued for a few weeks.

What is not normal?

Contact your surgeon or attend your nearest emergency department if you have:

swelling in the neck or difficulty breathing.
signs of low calcium: pins and needles in the hands, feet or lips, muscle twitches or cramps or palpitations.
vomiting lasting more than a few hours.
severe pain not controlled by the prescribed pain medication.
fever >38 degrees for more than 24 hours.

When will I see the surgeon?

The surgeon will see you:

in the recovery room.
on the ward the next morning, including a nasal endoscopy to check the movement of the vocal cords.
In the office one week after surgery. You will be given an appointment card today.
and again in 6 weeks, with a blood test one day before that visit.

What should I do if I need help or advice?

Click here for information about Dr Clancy’s on call schedule.

Is there any more information specific to my situation?

If you have had the whole thyroid removed (total thyroidectomy) you will need to take a thyroid hormone tablet every day for the rest of your life.