Parathyroidectomy

What is Parathyroidectomy

Parathyroidectomy is a surgery to remove one or more parathyroid glands. These glands are in the neck. Each gland is very small, about the size of a pea. Most people have four parathyroid glands. The glands produce parathyroid hormone, which helps to control the level of calcium in the body.

You may have a parathyroidectomy if your body produces too much parathyroid hormone (hyperparathyroidism). This usually occurs when one or more of your parathyroid glands becomes enlarged from a type of noncancerous tumor (adenoma).

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Bleeding.
  • Infection.
  • Allergic reactions to medicines.
  • Damage to the nerves of your voice box (larynx). This can be temporary or long-term (rare).
  • Damage to nearby structures and organs, such as the skin (scarring), surrounding blood vessels, and nerves in the neck.
  • Hoarseness. This usually resolves in 24–48 hours.
  • A condition in which your body does not make enough parathyroid hormone (hypoparathyroidism). This is rare.
  • Difficulty breathing. This is rare.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
  • Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

  • You may be asked to shower with a germ-killing soap.
  • Plan to have someone take you home from the hospital or clinic.
  • Plan to have a responsible adult care for you for at least 24 hours after you leave the hospital or clinic. This is important.

What happens during the procedure?

  • To lower your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Hair may be removed from the surgical area.
    • Your skin will be washed with soap.
  • An IV will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to make you fall asleep (general anesthetic).
  • An incision will be made according to the type of parathyroidectomy procedure you are having. There are four methods that may be used:
    • Open surgery. A single incision will be made in the center of your neck. The incision will be about 2–4 inches long.
    • Minimally invasive surgery. A small incision will be made in the side of your neck. This incision will be about 1–2 inches long. Before the procedure, you might be given an injection of a type of medicine that will help the surgeon to locate the gland.
    • Video-assisted surgery. Two small incisions will be made in your neck. One incision is for the instruments that will be used to remove the gland. The other incision is for a tiny camera that will help the surgeon to see inside your neck.
    • Endoscopic surgery. An incision will be made just above your collarbone. A small, flexible tube (endoscope) will be inserted through this incision.
  • Your health care provider may monitor laryngeal nerve function during the procedure for safety reasons.
  • The gland or glands that are causing problems will be removed.
  • The incisions will be closed using stitches (sutures) or other methods. The sutures will often be hidden under the skin.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
  • You will be given pain medicine as needed.
  • Your provider will check your ability to talk and swallow after the procedure.
  • You will gradually start to drink liquids and have soft foods as tolerated.
  • Your blood will be tested to check the calcium level in your body.
  • Do not drive for 24 hours if you were given a sedative during your procedure.

Summary

  • The parathyroid glands are located in the neck and produce parathyroid hormone, which helps to control the level of calcium in the body.
  • A parathyroidectomy is a surgery to remove one or more parathyroid glands.
  • You may have a parathyroidectomy if your body produces too much parathyroid hormone (hyperparathyroidism).
  • There are four surgical methods that may be used for a parathyroidectomy: open, minimally invasive, video-assisted, and endoscopic.
  • Generally, this is a safe procedure. However, problems may occur, including bleeding, infection, and a hoarse or weak voice.

Parathyroidectomy, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Mild pain in the neck or upper body, especially when swallowing.
  • A swollen neck.
  • A sore throat.
  • A weak or hoarse voice.
  • Slight tingling or numbness around your mouth, or in your fingers or toes. This may last for a day or two after surgery. This condition is caused by low levels of calcium. You may be given calcium supplements to treat it.

Follow these instructions at home:

Medicines

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not drive or use heavy machinery while taking prescription pain medicine.
  • Do not take medicines that contain aspirin and ibuprofen until your health care provider says that you can. These medicines can increase your risk of bleeding.

Eating and drinking

  • Follow instructions from your health care provider about eating or drinking restrictions. You may need to have only liquids and soft foods for a day after the procedure.
  • To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
    • Drink enough fluid to keep your urine pale yellow.
    • Take over-the-counter or prescription medicines.
    • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
    • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.

Incision care

  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
  • Check your incision area every day for signs of infection. Check for:
    • Redness, swelling, or pain.
    • Fluid or blood.
    • Warmth.
    • Pus or a bad smell.
  • Do not take baths, swim, or use a hot tub until your health care provider approves.

Activity

  • For the first 10 days after the procedure or as instructed by your health care provider:
    • Do not lift anything that is heavier than 10 lb (4.5 kg).
    • Do not jog, swim, or do other strenuous exercises.
    • Do not play contact sports.
  • Avoid sitting for a long time without moving. Get up to take short walks every 1–2 hours. This is important to improve blood flow and breathing. Ask for help if you feel weak or unsteady.
  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

General instructions

  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing after surgery. If you need help quitting, ask your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important. Your health care provider needs to monitor the calcium level in your blood to make sure that it does not become low.

Contact a health care provider if you:

  • Have a fever.
  • Have more redness, swelling, or pain around your incision area.
  • Have fluid or blood coming from your incision area.
  • Notice that your incision area feels warm to the touch.
  • Have pus or a bad smell coming from your incision area.
  • Have trouble talking.
  • Have nausea or vomiting for more than 2 days.

Get help right away if you:

  • Have trouble breathing.
  • Have trouble swallowing.
  • Develop a rash.
  • Develop a cough that gets worse.
  • Notice that your speech changes, or you have hoarseness that gets worse.
  • Develop numbness, tingling, or muscle spasms in the arms, hands, feet, or face.

Summary

  • For a day or two after the procedure, you may have tingling or numbness around your mouth, or in your fingers or toes. Temporary hoarseness may also occur.
  • Follow instructions from your health care provider about how to take care of your incision. Watch for signs of infection.
  • Keep all follow-up visits as told by your health care provider. This is important. Your health care provider needs to monitor the calcium level in your blood to make sure that it does not become low.
  • Get help right away if you develop difficulty breathing, or numbness, tingling, or muscle spasms in the arms, hands, feet, or face.
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