Parathyroidectomy is the surgical removal of one or more parathyroid glands.
The parathyroid glands are four rice-sized glands located on back of the thyroid gland in the neck. The parathyroid glands make parathyroid hormone (PTH), which controls the levels of calcium in the body.
In patients with hyperparathyroidism, one or more parathyroid glands become enlarged and oversecrete parathyroid hormone, causing levels of calcium to rise in the blood.
Surgery to remove the enlarged gland (or glands) is the only definitive treatment for the disorder and cures it in 95 percent of cases.
With the use of accurate preoperative imaging studies and intraoperative parathyroid hormone measurement, minimally invasive parathyroidectomy via a 2-3 centimeter incision is possible in the majority of cases.
UCSF is a major referral center for endocrine surgery. Surgeons at UCSF perform a high volume of endocrine surgery procedures with generally excellent results.
In 85-90% of patients with primary hyperparathyroidism, only one gland is abnormal. This allows endocrine surgeons to perform a more limited, focused exploration where there is a high likelihood of having only a single abnormal gland.This approach is referred to as a "minimally invasive parathyroidectomy" or MIP and is the most common procedure performed today. The MIP procedure has the following advantages for patients:
- Less post-operative pain
- Faster recovery from surgery
- Small or barely visible scar
- Shorter hospital stay
- A more rapid return to work and normal activities
For a selected group of patients who are concerned about the possible cosmetic effects of a scar in the neck, we offer “scarless” parathyroidectomy, a technique of thyroid removal using small oral incisions that eliminates the neck scar. UCSF Endocrine Surgery is among the first programs in the world to offer this technique.
What are the risks of the operation?
There are three main risks for parathyroidectomy.
- Recurrent laryngeal nerve injury: This nerve controls your vocal cords and if injured you will have a hoarse voice. There is a 1% chance of permanent hoarseness and a 5% chance of temporary hoarseness (<6months).
- Low blood calcium: There are parathyroid glands that lie behind your thyroid gland that help to control your blood calcium levels. If they are injured or removed (can lie within the thyroid gland) during your operation, then your blood calcium can be too low. This would require you to take calcium and vitamin D supplementation. There is a 1% chance of permanent calcium supplementation and 5% chance of temporary calcium supplementation.
- Bleeding: There is a 1/300 risk of bleeding with your operation. This is the main reason you stay overnight in the hospital.
How do I prepare for surgery?
There is no reason to change your diet and/or most medications prior to your operation. You will be seen by the anesthesiologist at least one week prior to your surgery for a preoperative check. At this appointment there may be blood or other tests done to prepare you for your surgery. If you take blood thinning medications, such as aspirin, Plavix, ibuprofen, or Coumadin, you will need to contact the prescribing physician to discuss stopping these medications prior to your surgery.
How long is my hospital stay? Can I have someone stay with me overnight?
Most patients only spend one night in the hospital or may be discharged at the end of the surgery day depending on your case.. There is no guarantee for a private room or someone being able to spend the night with you.
What kind of scar will I have after surgery?
The incision is about 1-2 inches in length, and is placed in the midline of the neck in a normal skin crease to minimize scarring and visibility.
How do I care for the incision?
There will be Steristrips or surgical glue on your incision. These can be removed 10-14 days following your operation. There is no need to place any further dressing on your incision. You may use vitamin E oil or similar product to help the healing process, but it is NOT necessary. You SHOULD use sunscreen and/or cover to protect the incision from the sun. You may take a shower. It is OK to get it slightly wet, but not soaking wet.
What medications will I be taking after my operation?
Your blood calcium will be checked the night of your operation and in the morning following your operation. If your blood calcium level is low following your operation, you may experience hypocalcemia symptoms such as numbness/tingling and muscle cramping. These symptoms are relieved by taking calcium supplements (Tums, Oscal, etc) and, if needed, vitamin D (Rocaltrol). You can take 2 grams of calcium (4 tablets of 500mg Tums) every 4 hours as needed for your symptoms.
If you have persistent tingling despite taking calcium as directed, please call office 415-353-7687. Pain medication may be taken as necessary, and is usually only needed for three to four days following parathyroidectomy.
Do I need to donate blood (autologous or designated donor) prior to my surgery? It is highly unlikely that you will require a blood transfusion during your parathyroidectomy, and therefore not medically necessary to donate (autologous or designated donor) blood prior to your surgery.
Are there any restrictions following my operation?
You can resume regular activity as tolerated. Walking outside, going up and down stairs, and performing light activities are all encouraged. Avoid strenuous activity or lifting anything that weighs 10 pounds or more until you feel up to it. If you are feeling well and are not taking any pain medication, you may drive (usually the third or fourth day after surgery).
When can I expect to return to work?
In general, you can return to work when you feel ready, usually within one to two weeks.
Are there any dietary restrictions following my surgery?
Resume a normal balanced diet as tolerated. Be sure to drink plenty of fluids.
When should I have my post-operative appointment?
You should be seen by your surgeon approximately 2-4 weeks following your surgery. This appointment can be made by calling our office 415-353-7687.
When can I expect my pathology results?
In general, pathology results can expect to be final approximately 7-10 days. This may vary depending on the type of surgery. Special staining may be necessary and may delay results. Pathology results will be discussed at your post-operative appointment unless otherwise indicated.
How do I know if I need any further treatment?
If applicable, further treatment questions will be addressed at your post-operative appointment with the surgeon. Treatment options may also be discussed with your referring endocrinologist.