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Parathyroidectomy—Conventional

(Parathyroidectomy—Open; Parathyroidectomy—Standard; Parathyroid Gland Removal—Conventional; Parathyroid Gland Removal—Open; Parathyroid Gland Removal—Standard)

Pronounced: peh-rah-THIGH-roy-dek-tah-me
by Marjorie Montemayor-Quellenberg, MA

Definition

A parathyroidectomy is a surgery to remove parathyroid glands. There are four parathyroid glands located in the neck. The glands make a hormone that balance the level of calcium in the blood.

Parathyroid Glands and Thyroid Glands (Back View)

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Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

The surgery is done to remove one or more abnormal parathyroid glands. The glands may be abnormal due to cancer or for other reasons.

Possible Complications    TOP

Complications are not common, but no procedure is completely free of risk. If you are planning to have a parathyroidectomy, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Hoarseness
  • Low calcium levels in the blood (more common if all 4 glands are removed)
  • Wound infection
  • Reaction to the anesthesia
  • Skin tethering—tissues and skin may become attached to the voice box or windpipe
  • Scarring
  • Blocked airway
  • Damage to nerves (which can cause problems like paralyzed vocal cords)

Factors that may increase the risk of complications include:

  • Smoking
  • Alcohol abuse
  • Heart and lung problems
  • Prior neck surgery

Talk to your doctor about these risks before the surgery.

What to Expect    TOP

Prior to Procedure

Your doctor will:

  • Do a physical exam and ask you about your medical history
  • Order imaging test such as ultrasound or parathyroid scan
  • Have blood tests done

You should:

  • Arrange to have someone drive you home from the hospital after surgery.
  • Avoid eating or drinking 6-8 hours before surgery.
  • Talk to your doctor about your medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen)
    • Blood-thinning drugs, such as warfarin (Coumadin)
    • Anti-platelet drugs, such as clopidogrel (Plavix)

Anesthesia

General anesthesia is used most often. It will block any pain and you will stay asleep through the surgery.

In some cases, local anesthesia may be used instead. The area will be numb but you will be awake.

Description of the Procedure

An incision will be made in the neck. Muscle and other tissue will be moved to locate all the glands. The abnormal gland or glands will then be cut out and removed. A drain may then be placed in the area. This will allow fluids to drain out of the area while you heal. If all four glands were removed, a part of one gland may be placed in a different area of the neck or in the forearm. The incision will be closed with stitches.

How Long Will It Take?

20 minutes to several hours, depending on how many glands need to be removed

How Much Will It Hurt?

Anesthesia prevents pain during surgery. After the surgery, you may feel like you have a cold or sore throat. Your doctor will give you medication to help manage the pain.

Average Hospital Stay

You may need to stay in the hospital for 1-2 days. Your doctor may choose to keep you longer if you have any problems.

Post-procedure Care

At the Hospital

The hospital staff will:

  • Observe you in the recovery room.
  • Check on your ability to swallow and speak.
  • Show you how to change your dressings and care for your wound.
  • Remove the drain if one was placed during surgery.

At Home

Be sure to follow your doctor’s instructions. To help your recovery at home:

  • You may be given calcium supplements.
  • You will be given instruction about caring for your wound. Check your wound daily for signs of infection.
  • You may want to eat semi-solid foods like ice cream or oatmeal for the first few days. These types of foods will be easier to swallow.

Call Your Doctor    TOP

After you leave the hospital, contact your doctor if any of the following occurs:

  • Tingling or numbness in the fingertips, toes, hands, or around the mouth
  • Twitching or cramping of muscles
  • Redness, warmth, drainage, or swelling around the area where surgery was done
  • Difficulty swallowing, talking, or breathing
  • Signs of infection, including fever and chills

In case of an emergency, call for medical help right away.

RESOURCES:

The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS)
http://www.entnet.org/
The American Association of Endocrine Surgeons
http://www.endocrinesurgery.org/
National Cancer Institute
http://www.cancer.gov/

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca/
Canadian Society of Otolaryngology
http://www.entcanada.org/

References:

Farndon JR. Postoperative complications of parathyroidectomy. In: Holzheimer RG, Mannick JA. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich, Germany: Zuckschwerdt; 2001. National Center for Biotechnology Information website. Available at: http://www.ncbi.nlm.nih.gov/books/NBK6967/ . Accessed June 18, 2013.
Parathyroid surgery. The American Association of Endocrine Surgeons website. Available at: http://www.endocri... . Accessed June 18, 2013.
Parathyroidectomy. Cedars-Sinai website. Available at: http://acromegalys... . Accessed June 18, 2013.
6/6/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed May 2013 by Kim Carmichael, MD
Last Updated: 6/13/2013