PARATHYROID SURGERY

WHAT IS HYPERPARATHYROIDISM?

Your body has four parathyroid glands. They are small, pea-sized glands, located in your neck just behind your butterfly-shaped thyroid gland. Two parathyroid glands lie behind each 'wing' of your thyroid gland.

Your parathyroid glands release a hormone called parathyroid hormone. This hormone helps to control the levels of two chemicals in your body: calcium and phosphate.

Normally, parathyroid hormone is released when the level of calcium in your blood is low. When the calcium level rises and is back to normal, parathyroid hormone stops being released. Parathyroid hormone has a number of effects in your body:

  • It causes bone to release calcium.
  • It causes calcium to be taken up into your blood (absorbed) from your gut (small intestine).
  • It stops your kidneys from getting rid of (excreting) calcium in your urine.
  • It causes your kidneys to excrete phosphate in your urine.

In hyperparathyroidism, your parathyroid glands make and release too much parathyroid hormone. Generally, this means that the calcium level in your blood becomes too high.

If the calcium level is not well controlled:

  • The heart rate can slow down or beat too rapidly.
  • Muscles can to go into spasm (tetany).
  • You can become confused and even go in to a coma.

Treatment

Removal of some or all of the parathyroid glands can improve or cure symptoms.

Symptoms can include:

  • Weakened bones (osteoporosis) and bone pain.
  • Muscle weakness.
  • Kidney stones.
  • Fatigue (tiredness).
  • Stomach ulcers.
  • Depression.

The operation is then usually performed under a general anaesthetic so you are unconscious. Once you are asleep, the surgeon will make a small cut (5 to 7 cms or 2 to 3 inches) in your neck and will remove all or some of the parathyroid glands. The cut is then stitched and will heal to form a scar. The suture (stitch) is normally removed on the second day after surgery.

 

ARE THERE ANY RISKS OR COMPLICATIONS?

There are risks and complications associated with any surgery.

Your consultant will have discussed the risks and benefits of having this surgery with you.

The general complications of any operation include:

  • Pain. We will give you medication to control the pain. It is important you take your painkillers as instructed so you can start moving around and cough freely.
  • Bleeding. This may occur during or after surgery. You will have bruising and occasionally a haematoma (bleeding under the skin) may form. Sometimes this may mean further surgery.
  • Infection. Any break in the skin can be at risk of infection. We will advise you on ways to reduce the risk of infection by hand washing and the use of alcohol gel. If you do have an infection it may require treatment with antibiotics.
  • Scarring. You will have a scar that will normally be hidden by the natural folds of skin in the neck.

Specific risks and complications of this surgery include:

  • A hoarse voice that may occur if the nerves supplying the larynx are damaged. Whilst this usually settles over a few weeks, in a very small number of patients, this may become permanent.
  • Calcium levels in the blood may drop when the parathyroid glands are removed. You may experience muscle cramps or tingling around the mouth. This can be treated with calcium supplements. We will check your blood calcium levels daily whilst you are in hospital.
  • Breathing difficulties that may occur if there is swelling around the neck or nerve damage. These are temporary and will improve as the swelling goes down.

After the operation

You will be able to carry out your normal activities once you get home although you may feel a little more tired than usual for a couple of days. You will be able to eat and drink normally. If you feel tingling or spasms in your fingers or toes, contact your GP as this can be a sign that there is not enough calcium in your blood. 

Most people are able to return to work after two weeks although this will depend on the extent of your surgery and the type of work you do.

If you drive, you must make sure you can safely do an emergency stop before resuming driving. You should check with your insurance company if there are any restrictions after surgery.