What is Parathyroidectomy Surgery?
Parathyroidectomy is surgery to remove the PARATHYROID GLANDS or PARATHYROID TUMORS. The parathyroid glands are right behind your thyroid gland in your neck. These glands help your body control the calcium level in the blood.
Your doctor may recommend this surgery if one or more of your Parathyroid glands is producing too much parathyroid hormone. This condition is called hyperparathyroidism and is often caused by a small benign tumor called an Adenoma.
Your surgeon will consider many factors when deciding whether to perform surgery and what type of surgery would be best for you. Some of these factors are:
THE PROCEDURE
Usually the parathyroid glands are removed using a 2- to 4-inch surgical cut on your neck.
During the Traditional Open Approach, surgery:
In rare cases, when all four of these glands need to be removed, part of one is transplanted into the forearm. This helps ensure your body's calcium level stays at a healthy level.
The specific type of surgery depends on where the diseased parathyroid glands are. Types of surgery, other than the Traditional Open Approach include:
MINIMALLY INVASIVE PARATHYROIDECTOMY:
You may receive a shot of a very small amount of radioactive tracer before this surgery. This helps highlight the diseased glands. If you have this shot, your surgeon will use a special probe, like a Geiger counter, to locate the parathyroid gland. Your surgeon will make a small cut (1 to 2 inches) on one side of your neck, and then remove the diseased gland through it. This procedure takes about 1 hour.
VIDEO-ASSISTED PARATHYROIDECTOMY:
Your surgeon will make two small cuts in your neck. One is for instruments, and the other is for a camera. Your surgeon will use the camera to view the area and will remove the diseased glands with the instruments.
ENDOSCOPIC PARATHYROIDECTOMY:
Your surgeon will make two or three small cuts in the front of your neck and one cut above the top of your collarbone. This reduces visible scarring, pain, and recovery time. This cut is less than 2 inches long. The procedure to remove any diseased parathyroid glands is similar to video-assisted Parathyroidectomy.
This particular procedure will require a 1 night stay in the hospital.
PREPARATION FOR SURGERY
Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire, which will allow our doctors to determine your eligibility for Minimally Invasive Thyroid Surgery.
Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.
Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues. In addition, you may be asked to consult with a physical therapist to discuss recovery, hip rehabilitation and important precautions you must take postoperatively. The physical therapist may even give you exercises you can begin prior to your surgery in order to aid with recovery.
After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. Parathyroid glands are very small. You may need to have tests that show exactly where your glands are. This will help your surgeon find your parathyroid glands during surgery. Two of the tests you may have are a CT scan and an Ultrasound.
The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.
Preparation for the hospital
Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:
Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:
Morning of surgery
Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.
RECOVERY AFTER SURGERY
When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours, but some will need to stay overnight for observation.
You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.
You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk.
You will most likely be tired and a bit sore for a few days. You may have pain not only from your incision, but also from muscle soreness in your upper back and shoulders. This is from the positioning in the operating room during the surgery. You will have liquid pain medicine in the hospital and a prescription for pain pills at home.
You may have a sore throat. This is a result of the placement of anesthesia tubes during surgery. Throat lozenges and spray usually help.
Your neck may be slightly swollen as well. You may feel like you have a lump in your throat when you swallow. This will improve after a few days but may continue for a week or so.
Hospital discharge and home instructions
The recovery course will depend on the extent of additional surgery and the reconstruction performed along with the neck dissection. Some surgery might require staying in the hospital for one to two weeks.
With a neck dissection alone, you should be ready to go home after two to three days—and that’s only to allow the drain output to decrease.
Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom etc.
You will be able to leave the hospital when you are:
LIFE AFTER SURGERY
These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your surgeon’s discharge instructions if they are different from what is listed here:
Sometimes, another surgery is needed to remove more of the parathyroid glands.
If you notice sudden swelling in your neck contact our surgeon immediately. Your calcium level may drop after surgery. This is related to disturbance of the parathyroid gland, which regulate calcium balance. This will be monitored through blood tests. You may notice numbness and tingling of your fingers or around your mouth. You will have instructions about taking calcium replacement if needed.
Medications
Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.
Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.
Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.
FOLLOW-UP
Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need.