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What do I need to know about a parathyroidectomy?
A parathyroidectomy is surgery to remove part or all of your parathyroid glands. You have 4 small parathyroid glands that are near the thyroid gland. The parathyroid glands make a hormone that controls the amount of calcium in your blood. You may need this surgery if one or more of your parathyroid glands produces too much hormone. This may be caused by a benign (not cancer) tumor.
How to prepare for a parathyroidectomy:
- Your healthcare provider will tell you how to prepare for surgery. You may be told not to eat or drink anything after midnight on the day of surgery. Your provider will tell you which medicines to take or not take on the day of surgery.
- Blood tests are used to check the amounts of calcium and thyroid hormone in your blood. You may be given antithyroid medicine to lower the amount of thyroid hormone made by your thyroid gland.
- A scan may be done right before your surgery to help healthcare providers know which parathyroid glands are overactive. Radioactive dye is put into your IV to help healthcare providers see your parathyroid glands and know which glands need to be removed. Healthcare providers will use a camera above your neck and chest to look for the parathyroid glands that absorbed the dye.
What will happen during a parathyroidectomy:
- You may have an open parathyroidectomy. An incision will be made in your neck. A handheld probe (wand) and video may be used during the surgery to find your parathyroid glands. Your surgeon will remove part or all of your parathyroid glands. If all 4 glands need to be removed, your surgeon may leave a small part of 1 gland in place. He or she may also put a small piece of gland into a muscle in your arm.
- You may instead have a minimally invasive parathyroidectomy. Your surgeon will place a scope through small incisions on your neck, or chest and underarm. He or she may insert other tools in 1 to 2 smaller incisions at different places on your neck or armpit. He or she will then inject a gas (carbon dioxide) in the neck area near your parathyroid gland. This will lift the skin of your neck away from the parathyroid and allow your surgeon more space to work in. Clips, cautery, loops, or staples may be used to separate the gland from other structures near it. Blood tests may be done during surgery to check your parathyroid hormone level. The incisions will be closed with stitches or surgical glue and covered with bandages.
- A drain may be placed in your wound to remove blood or extra fluid from the surgery area. The wound will be closed with stitches or surgical glue and covered with bandages.
What will happen after a parathyroidectomy:
A healthcare provider will check your incision soon after your surgery to make sure everything is okay. If you have a drain, your healthcare provider will check it when he or she checks your incision. He or she will remove it when your incision stops draining fluid.
Risks of a parathyroidectomy:
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. You may have a hoarse or weak voice that lasts for a few days or longer. You may get a blood clot in your leg or arm. This can cause pain and swelling, and can become life-threatening. Your blood calcium level may be lower than normal after surgery. Your condition could return and you may need to have surgery again.
Seek care immediately if:
- You cough up blood.
- You feel lightheaded, short of breath, and have chest pain.
- Your arm or leg feels warm, tender, and painful. It may look swollen and red.
- You have trouble swallowing or talking, or you lose your voice.
- You feel anxious, frightened, and uneasy.
- You have the following symptoms of low blood calcium:
- Muscle spasms or muscle tightening
- Numbness or tingling around your face, hands, or feet
- A seizure
Contact your healthcare provider or surgeon if:
- You have a fever.
- Your wound is red, swollen, or draining pus.
- You have pain in your neck area that does not go away, or gets worse even after you take your pain medicine.
- You have chills, a cough, or feel weak and achy.
- You have nausea or are vomiting.
- You have questions or concerns about your condition or care.
You may need any of the following:
- NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
- Acetaminophen decreases pain and fever. It is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Read the labels of all other medicines you are using to see if they also contain acetaminophen, or ask your doctor or pharmacist. Acetaminophen can cause liver damage if not taken correctly. Do not use more than 4 grams (4,000 milligrams) total of acetaminophen in one day.
- Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him or her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
Follow up with your healthcare provider or surgeon as directed:
You will need to return to have tests, your incision checked, and your drain or stitches removed. You may be referred to an endocrinologist. Write down your questions so you remember to ask them during your visits.
Check your wound for signs of infection, such as redness, swelling, or pus. You may need to wash the wound with soap and water. Pat the area dry and put on new, clean bandages as directed. Change your bandages when they get wet or dirty. Check your drain when you change the bandages. Do not pull the drain out.
Take supplements as directed:
You may need to take calcium medicine to keep your blood calcium level normal. It may also help prevent and treat bone loss. Your healthcare provider may also tell you to take vitamin D to help your body absorb the calcium.
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