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Transcript
Robert C Wright, MD, PS– Puyallup, Washington
Informed Consent – Parathyroidectomy
We have determined that you have a problem in one or more of your parathyroid glands requiring its
removal. The parathyroid glands regulate the amount of calcium in the blood, and when there is a problem
with the parathyroid glands, the blood calcium level will be too high. Most people have four parathyroid
glands, with two glands on each side of the neck, sitting immediately behind the thyroid gland. Parathyroid
diseases is usually a result of overfunction of one of the glands, but sometimes could be the result of
overactivity in all four of the glands. Parathyroid cancer is extremely rare.
Description of the Procedure
A low collar incision is made in the neck to hide the scar. The muscles surrounding the thyroid gland are
retracted, and the thyroid gland is carefully dissected free of the surrounding structures. Special care is made
to avoid the nerves to the voice box, and the parathyroid glands are identified behind the thyroid glands. The
parathyroid glands may occasionally be located in unusual locations, requiring a search through a portion of
the neck in an attempt to find all the possible glands. If a single gland alone is enlarged, it will be removed.
If all the glands are enlarged, 3 ½ glands will be removed, and the other ½ gland inserted in muscle of the
neck. A drain will sometimes be placed and the neck is closed.
Additional Procedures that may be done while in Surgery
1. Thyroidectomy – the parathyroid gland may occasionally be inside the thyroid gland (intra-thyroid). We
may also note a tumor on the thyroid gland that was not felt before surgery, necessitating removal of a lobe
of the thyroid gland.
2. Thoracotomy for intrathoracic parathyroid – if the parathyroid gland goes deep into the chest and cannot
be removed by a neck incision, the incision will be extended into the chest.
Risks/Complications of Treatment
In any medical treatment, it is impossible to predict all the things that could go wrong. Fortunately,
complications are the exception rather than the rule. Every reasonable effort is made to avoid complications.
The most common complications are as follows:
Possible complications following any operation
1. Bleeding – this is a problem that could happen any time the skin is cut. A blood transfusion is rare.
2. Infection – we take special care to prevent an infection, but it is always a possibility. An infection
may require prolonged hospitalization and treatment to resolve.
3. Reactions to medications – this could be many things from a minor rash to possible death.
4. Reactions to anesthesia and surgery – this could show up as a heart attack, blood clots, pneumonia,
sore throat, or potential death, in rare cases.
5. Poor wound healing – breakdown of the incision.
Possible complications of a parathyroidectomy
1. Problems with blood calcium levels – this will result from injury to the remaining parathyroid glands(s).
Corrections of this problem may require short-term or permanent calcium and vitamin D supplementation.
2. Inability to locate the problem gland(s) – the location of the parathyroid glands can be quite variable,
resulting in difficulty locating them at the time of surgery. Occasionally, there may be only 2 or 3 glands,
and sometimes there may be more than four glands. Reasonable efforts are made to locate all of the glands
in the neck. Occasionally, a lobe of thyroid tissue will be removed to identify the missing gland. In the
event the problem gland(s) are unable to be located and calcium levels remain high following surgery,
special studies will need to be done to identify the missing glands.
(see other side)
3. Injury to the recurrent laryngeal nerve or superior laryngeal nerves – injuries to these nerves may result
invariable outcomes, ranging from minor fatigue when talking for lengthy periods or a change in the voice, to
the need for a tracheostomy to permit breathing to occur.
4. Seroma/hematoma – a collection of fluid beneath the wound. If this happens immediately after surgery,
you may need to be urgently taken back to the operating room.
Anticipated Recovery/Expected Rehabilitation
Recovery is quite variable, depending on the individual and the disease being treated. Hospitalization
typically extends from one to two days. Recovery of full preoperative function usually takes four to six
weeks. Most people can return to work for “light duty” in one week. You may drive as soon as you are off of
pain medications. Most people will require lifelong thyroid medications, and this will need to be monitored.
Consent for Treatment
I understand my condition to be a problem with my parathyroid glands and am aware of its risks if
untreated. I have read and understand the above explanation of the procedure being proposed. My
surgeon has answered my questions, and I choose to proceed with surgery.
I understand that every operation may yield unexpected finding. I give the surgeon permission to act
on his best judgment in deciding to remove or biopsy tissues that appear to be diseased, understanding
that complications may arise from that action.
I understand that while most people receiving parathyroid surgery benefit from the operation, I may
not. My condition may not improve, and it may worsen. No absolute guarantee can be made.
HIPAA: Before and after surgery, unless otherwise requested in writing by you, visitors whom you
invite to attend the surgery will be informed of the surgical finding, your surgical status, and
anticipated recovery issues for effectiveness of communications. Because of the anesthetic, you may or
may not remember these important details.
PRINT NAME OF PATIENT __________________________________________________________________
SIGNATURE __________________________________________________________ DATE _________________
WITNESS ____________________________________________________________ DATE _________________
SURGEON ____________________________________________________________ DATE _________________
RELATIONSHIP TO PATIENT IF SIGNATURE OF LEGAL GUARDIAN ___________________________________
I waive the right to read this form, and do not want to be educated and informed of treatment risks;
nonetheless I understand the need for this surgery and grant permission to the surgeon to proceed on
my behalf.
SIGNATURE _____________________________________________________ DATE _________________
rev 5/27pjd