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December 24, 2019

Para Thyroid Surgery

Parathyroidectomy is the surgical removal of one or more parathyroid glands.

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.

Why the Procedure is Performed

Your health care provider may recommend this surgery if one or more of your parathyroid glands is producing too much parathyroid hormone. This condition is called hyperparathyroidism. It is often caused by a small non-cancerous (benign) tumor called an adenoma.

Your surgeon will consider many factors when deciding whether to do surgery and what type of surgery would be best for you. Some of these factors are:

• Your age
• Calcium levels in your urine and blood
• Whether you have symptoms

Symptoms of hypercalcemia

Symptoms can be vague in the early stages of hypercalcemia. As the condition progresses, you may have:

• fatigue
• depression
• muscle aches
• a loss of appetite
• nausea
• vomiting
• excessive thirst
• frequent urination
• abdominal pain
• constipation
• muscle weakness
• confusion
• kidney stones
• bone fractures

People with no symptoms may only need monitoring. Mild cases can be managed medically. However, if hypercalcemia is due to primary hyperparathyroidism, only surgery that removes the affected parathyroid gland(s) will provide a cure.

The most serious consequences of hypercalcemia are:

• kidney failure
• hypertension
• arrhythmia
• coronary artery disease
• an enlarged heart
• atherosclerosis (arteries with calcified fatty plaques that become hardened and abnormally function)

This may due to the buildup of calcium in the arteries and heart valves.

Risks

Risks for anesthesia and surgery in general are:

• Reactions to medicines or breathing problems
• Bleeding, blood clots, or infection

Risks for parathyroidectomy are:

• Injury to the thyroid gland or the need to remove part of the thyroid gland.
• Hypoparathyroidism. This can lead to low calcium levels that are dangerous to your health.
• Injury to the nerves going to the muscles that move your vocal cords. You may have a hoarse or weaker voice which could be temporary or permanent.
• Difficulty breathing. This is very rare and almost always goes away several weeks or months after surgery.

Before the Procedure

Parathyroid glands are very small. You may need to have tests that show exactly where your glands are. This will help your surgeon find your parathyroid glands during surgery. Two of the tests you may have are a CT scan and an ultrasound.

Before surgery, an anesthesiologist will review your medical history with you and decide what type of anesthesia to use. The anesthesiologist is the doctor who will give you the medicine that allows you to sleep and be pain free during surgery and who monitors you during surgery.

Tell your surgeon:

• If you are or might be pregnant
• What medicines, vitamins, herbs, and other supplements you’re taking, even ones you bought without a prescription

During the week before your surgery:

• Fill any prescriptions for pain medicine and calcium you’ll need after surgery.
• You may be asked to stop taking blood thinners. These include NSAIDs (aspirin, ibuprofen), vitamin E, warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and clopidegrel (Plavix).
• Ask your surgeon which drugs you should still take on the day of your surgery.

On the day of your surgery:

• Follow instructions about not eating and drinking.
• Take the medicines your surgeon told you to take with a small sip of water.
• Arrive at the hospital on time.

After the Procedure

Often, people can go home the same day they have surgery. You can start your everyday activities in a few days. It will take about 1 to 3 weeks for you to fully heal.

The surgery area must be kept clean and dry. You may need to drink liquids and eat soft foods for a day.

Call your surgeon if you have any numbness or tingling around your mouth in the 24 to 48 hours after surgery. This is caused by low calcium. Follow instructions about how to take your calcium supplements.

After this procedure, you should have routine blood tests to check your calcium level.

Outlook (Prognosis)

People usually recover soon after this surgery. Recovery may be fastest when less invasive techniques are used.

Sometimes, another surgery is needed to remove more of the parathyroid glands.

Alternative Names

Removal of parathyroid gland; Parathyroidectomy; Hyperparathyroidism – parathyroidectomy; PTH – parathyroidectomy

Patient Instructions

• Surgical wound care – open