Thyroid Surgery :: Parathyroid Surgery :: Adrenal surgery
A/Prof Miller's Parathyroid Information for Patients
Patient Info Sheet
What are the parathyroids?
The parathyroids are four tiny glands in your neck, two on each side of your
thyroid gland. They make parathyroid hormone (PTH) which controls the level of
calcium in the blood. Calcium is very important for the normal functioning of
muscles, nerves, and bones. It is absorbed through the intestines and stored in
the bones. Parathyroid hormone raises blood levels of calcium by increasing
intestinal absorption of calcium, and by dissolving calcium from the bone into
What is hyperparathyroidism?
Some people make too much parathyroid hormone, a condition called
hyperparathyroidism. This condition is most common in middle-aged women,
occur in men or women at any age and can run in families. In 9 of 10
with hyperparathyroidism, the cause is a single benign tumour. In one
of 10, all
four parathyroids are enlarged. Cancer is exceedingly rare.
What are the symptoms of hyperparathyroidism?
The body does not like having blood calcium levels too high, and tells you in
number of ways.
Hyperparathyroidism can cause
. weak bones, called osteoporosis, which can lead to fractures
. kidney stones, renal impairment
. high blood pressure
. abdominal pain
. increased frequency of urination
. stomach ulcers and pancreatitis
. psychiatric problems
. arrythmias and heart disease
. difficult to control blood sugar if you are diabetic
Other symptoms are much more subtle, and include
. weakness and fatigue, loss of energy
. memory and concentration problems
. muscle and joint aches and pains
. abdominal and back pains
. feeling "older" than you should
. mood swings or depression
IMPORTANT ***These non-specific, vague symptoms
happen with high calcium no matter if it's only slightly high or very high. High
calcium is never normal and should not be "watched." These vague symptoms
improve in 85% of patients after successful parathyroid surgery. Most patients
who thought they had no symptoms, in retrospect, realize they did have these
symptoms and feel much better within weeks after surgery. They frequently say
things like: "I feel 10 years younger," and "you have given me a new body." Bone
density also improves, reducing the risk of fractures.***
Treatment of hyperparathyroidism
The only effective treatment for hyperparathyroidism is surgery to remove the
overactive gland(s). In the hands of an experienced endocrine surgeon, surgery
can cure the condition in 98% of cases. There is no effective non-surgical
for hyperparathyroidism. Before surgery, you will have a sestamibi
scan (a painless scanning test) and a neck ultrasound to see if there is one
enlarged gland that can
be located. If the abnormal gland is seen, you can have
"parathyroid mini-surgery" though a very small incision, and possibly go home
the same day. Even if the gland
is not seen, it can still be found at surgery in
98% of cases. The surgery takes about
one hour, and the incision is on your
neck. You will be completely asleep during the operation, and will feel no pain.
Recovery is quick, with most patients going home the same day or the next day,
and feeling very little discomfort. Most are back at work
in a few days!
Frequently Asked Questions
Is there any other treatment besides surgery?
No. Surgery is the only effective treatment of hyperparathyroidism.
What if I don't have the surgery?
Even if you think you have no symptoms, you will almost certainly feel much
after you are cured. If you don't have surgery, you will continue to have
high blood calcium, and many symptoms listed above. Without surgery, your bones
to become weaker, and possibly break. There is evidence of
increased risk of high
blood pressure, stroke, heart disease, and even shorter
life expectancy, from
How long will I be hospitalized?
Most patients are able to go home the same day (after parathyroid
or the following day.
What type of anesthesia will I have?
You will have a general anesthesia. You will be completely asleep during the
When will I know the results of the surgery?
The calcium levels generally return to normal within 12-48 hours of surgery.
Will I have a scar?
Yes. All surgery causes scarring, and how a patient scars is dependent on the
individual. However, there are some techniques that surgeons use to minimize
scarring. These techniques include careful incision placement and hypoallergenic
suture material (to avoid inflammation). For parathyroid "mini-surgery," the scar
is about 1-2 inches. If you need a full neck exploration, it will be bigger. As
a general rule, no matter which operation you need, it is unusual to have a very
noticeable scar after six months. Scars continue to fade for three years.
Will I have pain after the operation?
All operations involve some discomfort, but most patients are surprised at how
little pain they feel after this operation. Although you should be able to eat
and drink normally, the main complaint is sore throat and discomfort with
swallowing for 1-2 days. Most patients take Panadol or Nurofen to keep them
comfortable at home. You will have a prescription for something stronger for the
first few days in case you need it, but beware prescription pain medicine can
make you drowsy and constipated, so do not drive, drink lots of water and eat
plenty of fruits and vegetables.
Will I have stitches?
You will have stitches on the inside that dissolve on their own. You will have a
waterproof Comfeel dressing so that you can shower or bathe as usual (but do not
submerge the incision for 5 days). Leave the dressing in place until your first
post-operative visit, where it will be removed.
Will I have any physical restrictions after my surgery?
Your activity level depends on the amount of discomfort you experience. Many
patients have resumed golf or tennis within a week after the operation. Most
patients return to work in a week, and you are able to drive as soon as your
head can be turned comfortably without prescription pain pills (this limitation
is for driver safety).
What are the possible complications of parathyroid surgery?
The nerves that control your voice are very closely associated with the
parathyroid glands. Temporary voice changes are not uncommon, but usually
resolve within weeks to months. In 1 in 100 parathyroid operations, the nerves
that control the voice are permanently affected. When this occurs, the main
difficulties are projection of the voice and production of high pitched sounds.
It is usually described as hoarse, but will not necessarily be considered
abnormal by strangers.
Sometimes the surgery will not cure the hyperparathyroidism. In the hands of an
experienced endocrine surgeon, failure to cure occurs in fewer than 2 in 100
patients. Sometimes the normal parathyroid glands become "lazy" because the
abnormal gland was doing all the work. They may take some time to recover, so
some patients require extra calcium tablets on a temporary basis. Rarely, the
parathyroids do not recover, and calcium and vitamin D may be needed on a
permanent basis. In rare instances, the tumour can recur. Lifelong yearly blood
tests are recommended.
There is a small risk of bleeding into the wound. If this happens, it may be
necessary to have a second operation to evacuate the blood so it does not
interfere with your breathing. Infection is relatively uncommon, and is easy to
treat should it occur.
WHAT ARE THE RISKS OF PARATHYROID SURGERY?
As with anything in life, there are risks to surgery. These risks are weighed
against the risks of not having surgery. Listed below are some of the possible
complications of surgery. Risks include, but are not limited to:
. Permanent voice hoarseness...........<1%
. Failure to cure the hyperparathyroidism......<2%
. Permanent hypoparathyroidism........< ½ % (0% for mini-surgery)
. Infection of Incision........................................... Less than 1%
. Haematoma or Bleeding..................Less than 1%
. Seroma (fluid collection)..........1% (temporary)
. Swelling and black/blue....................................About 5%
. Keloid or overgrown scar.........rare
Other unforeseen risks
You will require general anaesthetic, given by a specialist anaesthetist.
Risk of a serious complication in a healthy person is very rare. Potential risks
include, but are not limited to:
. Heart problems (death, heart attack, arrhythmias)
. Lung problems (pneumonia, wheezing)
. Blood clots (stroke, clots in leg veins or lungs)
. Drug reactions (also possible with local anaesthetic)
. Chipped teeth
. Other unforeseen risks
You will meet the anaesthetist before your operation and have the chance to
discuss these further.
PREPARATION for SURGERY
- Please shower at home the evening before surgery or in the morning.
- Please do not shave the surgical site! It will be done for you if
necessary. Shaving yourself may increase the risk of infection.
- For morning surgery, Do Not Eat or Drink anything after midnight the night
before surgery unless otherwise instructed. This includes coffee, tea, water,
and juice! Medication with a small sip of water is OK. For afternoon surgery,
a small breakfast BEFORE 7AM is OK, and nothing after that. Your surgery may
be cancelled if you do not follow these instructions.
- Do Not Drink Alcoholic beverages 24 hours prior to your surgery.
- Do Not Smoke for 4 weeks before surgery or your risk of serious
- Ask us if you are permitted to take your routine medications (such as
those for heart, blood pressure, or insulin etc.) before arriving for surgery.
- Stop aspirin, warfarin, anti-inflammatories, or any other blood thinner
5-7 days prior to surgery
- Do Not bring valuables such as money, jewelry etc. Do not wear make-up.
- Bring toiletries and loose fitting, comfortable clothing to wear upon
- You will be required to remove contact lenses, jewelry, dentures, and wigs
- Arrange for a responsible adult to drive you home after discharge.
- Notify us if there is a change in your condition prior to surgery (such as
a cold, cough, fever or infection). If severe, your surgery may need to be
postponed for your safety.
- Stop all herbal medications 4 weeks before surgery unless discussed
beforehand. Especially Ginseng, Garlic, and Gingko, or St. John's Wort, which
increase the risk of bleeding.
CARE OF YOUR INCISION
- You will have a waterproof comfeel dressing on. Please leave it in place
until the first post-operative visit.
- You may shower 24 hours after surgery and pat dry over the dressing
- If the dressing comes off prior to your first doctor's visit, you may
apply a new dressing. If it is more than 3 days since the surgery, it's also
OK to leave the dressing off
- Some numbness, tightness, swelling, and bruising around the incision is
- For the best cosmetic result, keep your incision out of the sun for one
year after surgery.
- Call your surgeon or your local doctor if you have a temperature >38.3 or
chills, increasing pain, heat, and redness around the incision, or a
foul-smelling or creamy discharge. These are all signs of an infection that
may require antibiotic treatment or drainage.
THE DAY of YOUR SURGERY
- On the day of your surgery, report to reception, MPH, Level 1.
- If you have not already done so, you will meet your anaesthetist
- You may need a blood test or ECG prior to surgery
- After the operation, you will some time in the recovery room before going to
After discharge, you are not permitted to:
- Drive a Car nor operate power equipment
- Drink Alcoholic Beverages
- Sign important papers
The above are not permitted on the day of surgery, nor while taking any
prescription pain medication. Instructions regarding safe resumption of the
above activities will be provided by your surgeon.
Post-Operative Instructions for Parathyroid Surgery
Below are general instructions for patients who have had thyroid or
parathyroid surgery. Since individual circumstances may vary, it is important
that you discuss your individual post operative care with us.
Monitoring Your Progress
You should feel improvement every day after surgery. If you have any
questions regarding your progress, call our office. You should make a follow up
appointment approximately 1-2 weeks after your surgery.
Your incision is covered with a waterproof protective dressing. You can
shower and wash your hair as usual, but do not soak or scrub the dressing. After
showering, pat dry. Your dressing will be removed at your first post-operative
visit. If you experience itching once the dressing is off, you may apply lotion
to the scar. You might notice bruising around your incision or upper chest and
slight swelling behind the scar when you are upright. In addition, the scar may
become pink and hard. This hardening will peak at about 3 weeks and may result
in some tightness or difficulty swallowing, which will disappear over the next 3
to 4 months. You will also notice some numbness of the skin of your neck. This
will gradually improve over time.
The main complaint following parathyroid surgery is discomfort with
swallowing. Some people experience a dull ache, while others feel a sharp pain.
This should not keep you from eating anything you want, but the pain can be
annoying for a day or two. Nurofen or or Panadol is generally enough to control
this pain. Some people prefer Panadeine, but in general, stronger medications
are not necessary for long. You may feel like you have phlegm in your throat.
This is usually because there was a tube in your windpipe while you were asleep
that caused irritation that you perceive as phlegm. You will notice that if you
cough, very little phlegm will come up. This should clear up in 4 to 5 days.
Your voice may go through some temporary changes with fluctuations in volume
and clarity (hoarseness). Temporary changes are quite common. Generally, it will
be better in the mornings and "tire" toward the end of the day. This can last
for variable periods of time, but should clear in 4-6 months at most. There is a
small (1/100) risk of permanent hoarseness.
Hypocalcemia and Bone Health
Your bones have been starved of calcium during the time you have had
hyperparathyroidism, and will now have the chance to grow strong again. After
successful parathyroid surgery, I recommend you take Caltrate Plus twice a day
(available at any chemist) to promote healthy bones. In addition to these
supplements, an exercise routine using weights is also recommended
In about 20% of patients who have parathyroid surgery, the remaining parathyroid
glands have become lazy, and do not function properly immediately after surgery.
. This is usually temporary and causes the blood calcium level to drop below
normal (hypocalcaemia). Symptoms of hypocalcaemia include numbness and tingling
in your hands, soles of your feet and around your lips. Some patients experience
a "crawling" sensation in the skin, muscle cramps or headaches. These symptoms
appear between 24 and 48 hours after surgery. It is rare for them to appear
after 72 hours.
Hypocalcaemia is treated with extra calcium tablets. You should purchase Calcium
with Vitamin D (Caltrate) tablets before surgery so you have them at home. If
you feel you need it, take two extra tablets (there is no danger in taking it,
even if you do not need it.) The symptoms of tingling/numbness should improve
within 30 minutes of taking the tablets. If they do not disappear, you should
call my office.
You should repeat the dose whenever the symptoms return. This may mean that you
are taking as many as 2 tablets every 3 hours. It is important that you keep us
informed. The hypocalcaemia should disappear over a few weeks. If it does not,
let us know.
CONTACT MY OFFICE for any of the following symptoms:
. Fever >38.3 or chills
. Increasing pain or redness around incision
. Difficulty breathing
. Tingling around the lips or fingertips not relieved by calcium tablets
. Severe muscle cramps
AN IMPORTANT WORD ABOUT THE COSTS OF TREATMENT
Insurance rebates have not kept pace with the cost of running a medical
practice. As a consequence, there will be a gap to pay for the surgical fee and
for the anaesthetist. Your insurance company might also charge you an excess for
a hospital admission. We will advise you about expected out-of pocket costs not
covered by insurance. If these costs represent an undue hardship for you, please
discuss them with us.
ASK YOUR DOCTOR
We are here to help you. If you have any questions, please ask. It is often
helpful to bring a family member with you to a consultation, or to write
questions down so you won't forget them.