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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. • • • • • 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.