Download Parathyroidectomy Purpose The parathyroid glands are a set of four

Parathyroidectomy
Purpose
The parathyroid glands are a set of four small glands that sit behind the thyroid gland in the middle of the
lower neck. They produce a hormone responsible for regulation of calcium levels in the blood and bone. The
most typical problem leading a patient to parathyroidectomy is overproduction of this hormone. In most cases
this is due to one gland that has enlarged (parathyroid adenoma) but sometimes it can be due to multiple
lands enlarging (parathyroid hyperplasia). Parathyroid cancer is extraordinarily rare.
Procedure
Parathyroidectomy is performed in the hospital under general anesthesia. An incision is made horizontally in
the skin of the lower neck. Attempts are made to camouflage the incision in a natural skin crease. The
parathyroid glands are identified underneath the thyroid gland and then removed if obviously enlarged. If
there is question about the degree of enlargement, a "frozen section" is sent to the pathologist. The
pathologist immediately evaluates the specimen and tells if the pathologist immediately evaluations the
specimen and tells if the parathyroid is abnormal.In certain cases, a scanning device aids the search for the
parathyroid tissue. If only one gland is enlarged it is typically removed and the surgery is ended. If all the
glands were enlarged 90% of the parathyroid tissue (3 and 1/2 glands) are removed. The remaining portion of
the gland may be left intact or re-implanted in the forearm. A drain is placed to prevent formation of a blood
clot underneath the skin. The incision is precisely closed to minimize scarring. Patients stay one to two days
in the hospital after the procedure. The drain will be removed prior to discharge. Blood calcium is checked
while in the hospital.
Recovery
After discharge from the hospital patients should rest at home with the head elevated. You should expect mile
to moderate neck pain and some pain with swallowing. A regular diet can be resumed almost immediately
after surgery. The incision should be cleansed with peroxide twice a day. A light coating of antibiotic
ointment may be applied after cleansing. The stitches will be removed during your office visit one week after
the surgery. Most patients miss one to two weeks of work after surgery.
Risks and Complications
This section will highlight what we consider the most important risks of the procedure. Other
complications are also possible. Please talk to your doctor if you have more questions.
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Hypocalcemia
Most patients undergoing parathyroid surgery start out with high calcium levels. After the surgery the
levels should drop to normal, but the blood calcium can drop to very low levels. It may take several days to
weeks for the calcium levels to normalize. Permanent hypocalcemia requiring calcium supplementation can
occur) but this is uncommon.
Vocal Cord Paralysis
The nerves that go the vocal cords lie near the parathyroid glands. This nerve is carefully identified and
preserved. If the nerve is injured there can be temporary or permanent weakness of the vocal cord. If this occurs
on one side you can be hoarse and/or have some swallowing difficulties. If that occurs on both sides you may
have difficulty breathing. The incidence of permanent nerve injury is about 1 to 2% of cases.
Hypercalcemia
In some cased, there are continued high calcium levels. This usually indicated that there is more than one
abnormal parathyroid gland. A parathyroid gland can be difficult to locate if it is located in the chest or other
abnormal location. The current use of preoperative nuclear medicine scanning and intraoperative localization
had made this situation less likely.
Bleeding or Infection
These are possible with all types of surgery. There is not a high incidence of either of these problems with
this type of surgery. Blood transfusion for parathyroid surgery would be extraordinarily rare. Antibiotics may be
given to avoid infection.
Undesired Scarring
Despite careful technique it is still possible for the incision to heal with an unsatisfactory appearance.
Scar revision is possible if this occurs.
We ask that you sign below to indicate that you have read, understand, and accept the risks and complications
of this operation. Alternative treatments have been discussed with me and I want to go ahead with the
surgery.