Parathyroid surgery
PARATHYROID GLANDS:
There are usually four parathyroid glands which are located next to the thyroid gland in the neck. Rarely, there may be a fifth or sixth gland. Occasionally, one or more parathyroid glands may be located elsewhere in the neck or upper chest region. The parathyroid glands make parathyroid hormone (PTH) which helps your body regulate calcium levels. Parathyroid hormone keeps the amount of calcium from falling too low by releasing calcium from the bones, by keeping calcium from being excreted by the kidneys, and by increasing calcium absorption from food.
HYPERPARATHYROIDISM:
Hyperparathyroidism occurs when the parathyroid gland(s) enlarge and make too much parathyroid hormone. This leads to a rise in calcium levels. Hyperparathyroidism occurs sporadically in approximately 90% of cases and is inherited in ap- proximately 10%. There is also an association with previous therapeutic head and neck irradiation. There are approximately 100,000 new cases each year in the U.S. It occurs more commonly in women than in men.
SYMPTOMS:
Symptoms associated with high levels of calcium are often vague. They may include decreased appetite, thirst, lethargy, fatigue, muscle aches, weakness, joint pain and constipation. More severe symptoms and signs associated with higher levels of calcium may include stomach upset, depression, osteoporosis, fractures or kidney stones. Sometimes there are no symptoms and the condition is discovered only by routine laboratory blood work.
A single enlarged parathyroid or parathyroid adenoma is responsible for 80% of cases. Enlargement of all four glands, known as hyperplasia, accounts for about 15% of cases. In approximately 4% of patients, two glands are enlarged. Parathyroid cancer causes hyperparathyroidism less than 1% of the time.
Parathyroid surgery
Hyperparathyroidism can be cured with surgery. The purpose of parathyroid surgery is to locate and remove the abnormal parathyroid gland(s). When performed by an experienced endocrine surgeon, the operation is successful in approximately 97% of cases. Complications can occur, but are uncommon. Rarely, all four para- thyroid glands need to be removed and sometimes, a portion of one is transplanted into the forearm. The hospital stay for these cases may be more than one night depending on the calcium level after surgery. Your surgeon will explain your specific surgery and why it is recommended in your case.
As with any surgical procedure, there are risks involved. There is a risk of bleed- ing, but this is extremely low. The risk of infection is also extremely low that antibiotics are not routinely used. There is also a very low risk of injury to the recurrent laryngeal nerves which control the vocal cords. Inju- ry to these nerves could affect your voice. There is also the possibility that the abnormal glands could not be located or that your symptoms may recur over time. Occasionally, hypoparathyroidism may result after surgery. This is associated with low calcium levels and may require calcium and vitamin D supplements to maintain normal calcium levels. There is also a small risk associated with anesthesia. The overall risk of complications is extremely low, however, and is usually out- weighed by the benefits of surgery. Dr.Kandil will go over this information with you and answer your questions.
Before surgery
Once the surgery has been scheduled, arrangements will be made for your preoperative evaluation. You will meet with a nurse practitioner or physician’s assistant from the Anesthesiology Department. The pre-op exam may include laboratory work, chest x-ray and an EKG.
If you take non-steroidal anti-inflammatory agents, you should stop taking these one week before surgery. On the night before surgery, do not have anything to eat or drink after midnight. Get a good night’s sleep.
The day of surgery
Your doctor’s secretary will let you know where your surgery will be and what time you need to arrive at the hospital on the day of surgery. It is very important to arrive at least 2 hours before surgery. During the surgery, your family can wait in the family waiting area. They will be kept updated by the patient representative and operating room staff. The surgeon will speak with them after surgery has been completed.
What will happen in surgery?
You will be given general anesthesia to put you to sleep. You are positioned with special pillows under your neck to tilt your head back. An incision is made at the base of your neck and is about two to four inches long, depending on the exact type of operation you have. Using magnifying lenses, the surgeon locates the par- athyroid glands and the abnormal one(s) are removed. The incision is stitched closed and is then covered with Steri-strips (tapes) and a dry gauze dressing.
The operation generally lasts from 30 minutes to 90 minutes. After surgery, you will stay in the recovery room for several hours. Depending on the exact type of surgery you have, you will either be discharged home on the same day of surgery or be admitted for one night’s stay.
After surgery
If you are admitted to the hospital, you will have a liquid diet for dinner. You may have a sore throat. The nurse will provide lozenges to help relieve this. If you need something for pain, the nurse will give you a liquid pain medicine. You will have a dressing on your neck which will be removed in the morning. The head of your bed will be raised to decrease swelling. You will have an intravenous line to give you fluids until the next day. Your calcium level will be checked by a blood test in the morning. You will be offered regular food the next morning. Most people are ready to go home after breakfast.
You will be given instructions about taking calcium supplements and possibly Vitamin D (Rocaltrol).
Same day surgery
If you are discharged on the day of surgery, you will have plastic dressing over your incision. You may shower on the night of surgery, but keep the dressing as dry as possible. Two days after surgery, remove the plastic dressing and gauze. Your diet may consist of liquids and soft foods, depending upon which feels better to you, since your throat will be sore.
The incision
After the dressing is removed, you may shower. Try to keep the neck area as dry as possible and pat dry after showering. The stitches will be removed in the office about a week and a half after surgery. Infection is extremely rare.
You can do to improve the appearance of your scar is to protect it with scar cream or sunscreen that has a sun protection factor (SPF) of 30 for an entire year. During the year your scar may become raised or red, but will almost always fade into a thin line which will be less noticeable.