Parathyroid Surgery
Where are the parathyroids and what do they do?
The parathyroid glands are the size of a rice grain and sit around the butterfly shaped thyroid gland. There are usually 4 parathyroid glands. They secrete a hormone called PTH, which acts on many organs including the stomach, bones, and kidneys to increase the blood level of calcium. If you have been referred for consideration for parathyroid surgery by your doctor, it may be because they have found a high calcium level in your blood.
Why do I need a parathyroid surgery?
Removal of one or more of your parathyroid glands is required for the following reasons:
- Weakening of your bones producing osteopenia or osteoporosis
- Kidney stones
- Kidney failure
- Very high blood calcium level
- Tiredness, fatigue and forgetfulness
- To prevent the complications of untreated hypercalcaemia in a healthy asymptomatic patient
What type of scar will I have?
Professor Sidhu will offer a key hole operation where possible. The majority of patients can have a keyhole operation. The neck incision for this is 2-2.5cm. Prior to surgery, where appropriate, you may have a sestamibi scan, ultrasound and/or CT scan to localise the abnormal gland producing your high calcium. If localisation is possible this increases the probability of being able to have a key hole procedure.
If the abnormal gland can not be localised prior to surgery Professor Sidhu may undertake a four gland exploration. The incision for this procedure will be approximately 5cm.
Professor Sidhu will make the incision in an existing crease within the neck wherever possible.
Post-operative care of the wound will assist to reduce the visibility of scarring. Following surgery the wound will be stitched with dissolvable stitches, it will be covered with surgical tape. If the surgical tape comes off before your post-operative review it can be replaced with micropore tape which is available at most pharmacies.
What can go wrong?
Everyone is naturally worried about having their throat cut through parathyroid surgery. It is not possible for a parathyroid surgeon to give a patient a guarantee of no complications. However, after having performed over 5,000 operations on the neck, patients can be reassured that risks of problems occurring are small and when they do occur Professor Sidhu has the expertise to manage them.
Specific Risks of parathyroid surgery
- Permanent voice change - <0.5%
- Inability to raise the voice - 1-2%
- Permanent total or partial hypoparathyroidism requiring calcium /or vitamin D tablets - 2-3%
- Bleeding requiring reoperation - <0.5%
- Wound Infection - <1%
- Keloid or hypertrophic scar - rare
Parathyroid Surgery - What you should know
Parathyroid glands are the small glands located in the neck behind the thyroid gland. These glands regulate the amount of calcium in the body including the amount of calcium in the blood as well as in the bones.
The main reason for requiring parathyroid surgery is when you are diagnosed with primary hyperparathyroidism, which is often caused by a non-cancerous growth in one of the four parathyroid glands. The abnormal growth produces excessive parathyroid (PTH), which often leads to high levels of PTH and calcium in the blood.
To make an appointment to confirm if you need parathyroid gland surgery, you can call Professor Sidhu's rooms on (02) 9437 1731.
Before Surgery
What time should I go to hospital?
If you are having an operation in the public hospital, the hospital will contact you about 1 month prior to surgery and ask you to attend for a preoperative assessment by the hospital anaesthetic team. The hospital will notify you of the time to arrive on the day of your operation.
In the private hospital setting, your date will be allocated at the time of consultation or soon thereafter and you will be seen by your private anaesthetist prior to or on the day of surgery. The private hospital will notify you, the day prior to surgery, of the time to arrive on the day of your operation.
Do I need to fast?
Yes, you do. Patients having morning surgery need to be fasted from 12 midnight and patients having afternoon surgery are permitted to have a light breakfast and fast from 0700 hours.
Medications
All patients who are taking any of the below blood thinning medication must inform Prof Sidhu or his team at the time of booking surgery.
- Plavix
- Xarelto
- Eliquis
- Apsirin
- Warfarin
- Clopidogrel
Professor Sidhu will discuss these medications at the time of consultation.
Neck exercises
To gain access to the parathyroid glands the neck is tilted backwards. To help relieve soreness and swelling we recommend neck exercises prior to the surgery. Neck exercises booklet can be found here.
In Hospital
Your parathyroid surgery is undertaken using a general anaesthetic: you will be asleep for the operation. Local anaesthetic is used in the neck area to numb the skin for 12-16 hours after surgery. The anaesthetic tube used during surgery can sometimes cause a sore throat afterwards. You will be given tablets for pain relief afterwards. Sometimes by having the neck extended during parathyroid surgery, patients complain of pain in the back of their neck or head-neck exercises and physiotherapy do help in alleviating this pain.
You may wake up with an ice pack on your neck to be used for the first 12-24 hours to minimize skin swelling.
The hospital stay is usually for 1 or 2 nights. Most patients having parathyroids removed will stay 1 night.
After Discharge
All patients will be given a sheet to explain what to expect following the parathyroid surgery. If this does not happen, please download here.
The wound is closed with a dissolving suture and the steristrip dressing stays on for 10 days. You can shower as normal. After 10 days, the steristrip can be replaced with a brown micropore tape. This can be changed every 2 days. Professor Sidhu will review the scar at the post operative appointment and advise of ongoing scar management.
No driving is permitted for 3-4 days following the parathyroid surgery and you can return to work in 1-2 weeks depending on the type of work you do.
Normal Symptoms After Surgery
A number of symptoms can occur following parathyroid surgery, which you don't have to worry about. These are normal and will settle with time. They include:
- Sensation of difficulty swallowing
- Sensation of tightness in the neck without any obvious neck swelling
- Numbness in the skin above and below the incision
- Throat irritation from the anaesthetic tube
- Intermittent voice change. This can range from true hoarseness of voice all the time to fluctuations in volume and clarity especially towards the end of the day.
Recurrent laryngeal nerve injury is usually temporary in 2-3% of people and recovers in a few weeks following surgery.
Symptoms you do have to worry about
- Delayed neck swelling producing difficulty breathing
- Redness and heat in the wound with a high temperature over 38 degrees
If any of these symptoms occur after your parathyroid surgery, please contact Professor Sidhus team review the postoperative instruction sheet or go to your local GP or hospital if you are a country patient.