PARATHYROIDECTOMY 

The following information is for patients undergoing an operation to remove a parathyroid gland.

You will be in the hospital for usually 2-3 days. You will be assessed on the ward the week before your operation. This allows us to make sure that you are fit for an operation, to do a pre-operative blood test and to make a routine check on your vocal cords (this is done by passing a fine telescope down your nose under local anaesthetic). It also allows you to meet the junior doctors and nurses who will be looking after you during your stay on the ward. The anaesthetist, who is the doctor that will put you to sleep for the operation, will also review you. After your assessment you will be allowed home and you will then come into the ward on the day of your operation, having fasted (nothing to eat or drink) from midnight the night before.

The parathyroid glands are 4 little glands found on the back of the thyroid gland. They are responsible for controlling the level of calcium in the blood, and in your case they have become overactive. In most instances (85% of the time) only one of the glands has enlarged (called a parathyroid adenoma), and the surgeon removes this one gland. Occasionally (15%) of the time, all 4 of the glands are enlarged (called parathyroid hyperplasia), and in these cases the surgeon removes three and a half glands, leaving you with half a gland to maintain a normal calcium level in the blood. If you are a patient with a long-term kidney disorder, you will have parathyroid hyperplasia and will need to have three and a half glands removed. The operation on the parathyroid is done through an 8-cm skin crease incision across the front of the neck. The wound gradually fades away over a period of months and usually ends up hardly being noticed at all.

After your operation

The operation itself normally takes 1-2 hours. Following the operation you are kept in the theatre recovery area for around 3-4 hours and then returned to the ward. When you wake up, there will be a little drain in your neck with a dressing around it, and a drip in your arm. You will be allowed to drink the same night and the following morning the drip and the drain will be removed. You are encouraged to be as active as possible. Usually on the second day, after your operation, you will be allowed home. There will be one stitch under the skin, which will be removed by your GP’s nurse, five days after the operation. After a few weeks you can massage some cold cream, such as Astral or Nivea, into the wound, to help keep it supple. You are advised to avoid direct sun on your wound for at least six months after your operation.

You will normally be reviewed in the endocrine outpatient clinic approximately six weeks after your operation, when you will be reviewed by the surgeon. At this review you will have a blood test to check that the level of the calcium in the blood is normal, and to go over the results of the pathology of the removed parathyroid gland. Most patients are then followed up at the out-patient clinic annually for about 5 years, and if the calcium remains normal you are then discharged to the care of your GP.

Any operation can have potential risks, and there are a few risks that you should know about: -

¨ There is about a 1% chance of damage to the nerve that controls your voice box, which can leave you hoarse. Most patients are a little husky after the operation, but this is caused by having an operation on your neck and having a tube placed down your throat for breathing and usually settles after a few weeks.

¨ If you require three and a half glands to be removed (parathyroid hyperplasia), there is a 15% chance of initially becoming low in your blood calcium, while the half gland adopts to taking control of the blood calcium. In this cases the doctors can give you some calcium tablets to boost the level of calcium in the blood.

¨ There is around a 5% chance of an infection in your wound, the vast majority of which can be controlled by an antibiotic.

¨ There is about a 3% chance of significant wound bruising, which causes some swelling of the wound.

This information goes some of the way in answering a lot of the most common questions that we get asked by patients undergoing a parathyroid operation. However, you may have specific questions about the operation and we will be more than happy to answer your questions when you are admitted to hospital.

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Ó NHS Tayside; 2006; version 1.0

Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.