Parathyroidectomy

What you should know

• Parathyroidectomy is surgery to remove one or more of your parathyroid glands or parathyroid tumors (lumps). The parathyroid is made of four tiny glands in your neck that usually sit near the thyroid gland. The parathyroid glands make a hormone (special chemical) that controls the amount of calcium in your blood. Parathyroid hyperplasia is a condition where all four of the parathyroid glands are enlarged. If they are too big or overactive, you may have a condition called hyperparathyroidism. Hyperparathyroidism is when they make too much hormone and cause you to have too much calcium in your blood. This condition may also be caused by kidney disease, a lack of vitamin D in the body, or by tumors, such as adenomas or cancer. This may lead to serious health problems, such as weak bones, fractures (broken bones), kidney stones, heart problems, and depression.
  
  
• Parathyroidectomy surgery is the only treatment for hyperparathyroidism. Parathyroidectomy is also done for people who had minimally invasive parathyroid surgery and those who have multiple endocrine neoplasia (MEN) syndrome. During this surgery, your caregiver will make a 2 to 3 inch incision (cut) in the front of your neck. This is done so he can fully see and explore the structures that lie near the parathyroid glands. Your caregiver may also need to do imaging and blood tests during and right after the surgery. With parathyroidectomy, your hyperparathyroidism symptoms may stop and your quality of life improved.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• During or after surgery, you may bleed more than expected, or get an infection. Your thyroid gland, blood vessels, or other tissues may be damaged during surgery. You may have nerve or vocal cord damage, or have a hoarse or weak voice after your parathyroid gland or glands have been removed. This may last for a few days or longer. You may need more surgery to remove a parathyroid gland that is not located in your neck. You may have a lower than normal calcium level in your blood after surgery. Depending on the surgery that was done, your hyperparathyroidism could come back, or you could develop hypoparathyroidism (low blood calcium).
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• If you do not have surgery, your overactive parathyroid glands could cause too much calcium to build up in your blood. This could cause fatigue (tiredness), and bone, joint, or muscle pain. You may also have headaches, muscle spasms, weak bones, fractures (broken bones), hallucinations, and confusion. If you have a tumor on your parathyroid gland that is cancer and left untreated, this could be very serious. With this condition, your kidneys may not work correctly, or you may get kidney stones. You may get congestive heart failure. You could die from these conditions. Call your caregiver if you are worried or have questions about your condition, treatment, or care.

Getting Ready

The week before surgery:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• If you are a female, tell your caregiver if you think or know that you are pregnant.
  
  
• Tell your caregiver if you think or know that you may be having a kidney transplant.
  
  
• You may need to have blood tests, an electrocardiogram (ECG), chest x-ray, and other tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before surgery:

• Remove any nail polish.
  
  
• You may be given medicine to help you sleep.
  
  
• Ask caregivers about directions for eating and drinking.

The day of surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of your surgery. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Bring with you any papers your caregiver has given you to sign.
  
  
• If you wear contact lenses, do not wear them on the day of your procedure or surgery. Glasses may be worn.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• Do not wear tight-fitting clothes on the day of your procedure or surgery.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your surgery. Tell your caregiver if you or any member of your family has had a problem using anesthesia in the past.
  
  
• Your caregiver may give you an IV injection of a radioactive dye 1 to 2 hours before your surgery. This will help him clearly see your overactive parathyroid glands during surgery.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the surgery. It also explains the problems that may happen and your treatment choices. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

• You may be given medicine in your IV to help you relax or make you drowsy. You will be taken on a stretcher to the operating room and then moved onto a special bed. Caregivers may give you local or regional anesthesia to numb the surgical area. You may also be given general anesthesia to make you sleep during the surgery.
  
  
• An incision (cut) will be made in your neck, and the muscles of your neck will be pulled to each side. The thyroid gland will be moved aside to allow your caregiver to clearly see the four parathyroid glands. A hand-held probe (wand) and video may be used during the surgery. The parathyroid tumor, or one or more of your parathyroid glands, will then be removed. If all four glands need to be removed, your caregiver may leave a small part of one gland in place. He may also put a small piece of one gland into a muscle in your arm. Blood tests may be done during surgery. You may have a thin rubber tube (drain) placed in your skin to drain blood or fluid from your incision. Your incision will be closed and covered with bandages.

After your surgery:

You may be taken to a recovery room until you are awake. Caregivers will watch you closely for any problems. If you had general anesthesia, the ET tube will be removed after you are awake and can breathe well on your own. A caregiver will check your incision and drain soon after your surgery to make sure everything is okay. If you have a drain, it will be taken out later by your caregiver when your incision stops draining fluids. Try to avoid jerking movements and coughing. When your caregiver sees that you are okay, you will be taken to your hospital room.

Activity:

You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your appointment on time.
  
  
• You have a fever.
  
  
• You have a skin infection or an infected wound on or near the area where surgery will be done.
  
  
• You have questions or concerns about your surgery.

Seek Care Immediately if

• You have new symptoms since the last time you saw your caregiver, or your symptoms are getting worse.
  
  
• You feel too depressed or sad, or think that you cannot cope with life or your problems.