Harper Surgical Wellington - Parathyroid Surgery

Parathyroid Surgery

Patient information

What are the parathyroid glands?

Most people have 4 parathyroid glands which are small (about 3-4mm) yellow/brown structures normally found between the trachea (windpipe) and the thyroid gland. They are responsible for controlling the level of calcium in your body which they do by making ParaThyroid Hormone (PTH). This hormone works by its effects on your bones and kidneys.

Why might I need parathyroid surgery?

The most common reason is because you have a high calcium level in your blood. This is normally due to overproduction of PTH by one, or sometimes more than one, of your parathyroid glands (Primary Hyperparathyroidism). Often patients will have no symptoms of high calcium and the high levels have been discovered incidentally on a blood test. Surgery is normally recommended if the level of calcium in your blood is higher than a specific level or if you have other problems with your kidneys, weak bones or other organs directly related to high calcium. Some patients have symptoms which may be related to the high levels of calcium such as muscle weakness, fatigue, thirst, changes in heart rate, constipation or stomach ulcers. The symptoms caused by high calcium can be vague and it is hard to predict the likelihood of a particular symptom improving even after an operation which returns your calcium levels to normal.

Are there any alternatives to surgery?

There are medications which can temporarily lower your calcium levels. They do not cure the problem of an elevated PTH level and are not a routine alternative to surgery. There is a medication which can lower your calcium over the longer term but it is not routinely available in New Zealand and does not address the underlying problem of the overactive parathyroid gland(s) nor does it help with preserving bone strength.

What tests will I have before an operation is recommended?

Most patients will need blood and urine tests in order to confirm the diagnosis of Primary hyperparathyroidism. Once this is certain I will discuss the reasons you might benefit from surgery. If surgery is recommended, most patients will have an ultrasound scan of the neck and a special scan called a Sestamibi scan. Some patients may also have a CT scan.

What type of operation will I have?

This depends largely on the results of your scans. The scans are done to try and identify which of your parathyroid glands is overactive. When the overactive parathyroid gland is identified by both scans, minimally invasive parathyroidectomy can be considered. When the scans fail to find the gland or don’t agree on which gland is overactive a bilateral neck exploration is performed. Both operations take place with you completely asleep under general anaesthetic and you will normally spend one night in hospital.

Minimally Invasive Parathyroidectomy. This is performed through a 2-3cm incision in the neck. The aim is to remove the parathyroid gland previously identified on your scans. Blood tests are often used to confirm ‘cure’ while you are still asleep and if these test suggest that you have not been cured I will then perform a bilateral neck exploration before you wake up.
Bilateral Neck Exploration. This usually requires an incision of between 6-8cm. I will try to find all 4 parathyroid glands and remove those glands which are enlarged. Normally it is a single gland that is removed but about 15% of the time all 4 glands will be enlarged. In that setting I am likely to remove 3 1⁄2 glands. Rarely 2, or even 3 glands, are found to be enlarged and will be removed leaving the normal appearing glands behind

What can I expect after the operation?

I will give you a separate information sheet before you go home with instructions about wound care and answers to other common questions. Most patients find that they are tired for about a week after surgery but that the pain is well controlled with the simple painkillers I prescribe. Typically you will be ready to return to work about two weeks after surgery. Before you return to driving you need to be able to turn your neck freely.

What are the possible complications of parathyroid surgery?

Complications from this kind of surgery are rare but I will fully explain the risks to you.

Voice change. This can occur for a few reasons. It doesn’t happen very often and if it does it usually improves over time. Temporary voice change is due to ‘bruising’ or ‘stretching’ of the voice box nerves and can result in a deeper, hoarser or breathy voice. Damage to the external laryngeal nerve can lead to difficulty shouting or reaching higher notes when singing. Permanent damage to the voice is rare and occurs in about 1:100 operations. Permanent damage to both recurrent laryngeal nerves is extremely rare.
Low calcium levels. This is almost always temporary and we will check for this. You may be prescribed calcium tablets to treat this.
Calcium levels remain high. If the calcium levels remain high after surgery it probably means that you have not been cured. This occurs in about 3-5% of operations. In the event of this happening I will explain the next steps.
Bleeding. Bleeding into the neck after the operation is uncommon and sometimes needs to be treated with further surgery.
Scar. The scars from parathyroid surgery usually heal very well. Rarely they can become thick, raised or itchy. Talk to me about this if you have a tendency to forming this kind of scar.
Risks of the anaesthetic. These will be discussed with you in detail by your anaesthetist. You should ensure that you tell the anaesthetist your full medical history including any problems you or your family may have had with anaesthetics in the past. Feel free to ask them about the specifics of your anaesthetic.

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