Thyroid & Parathyroid Problems

Parathyroid Surgery

Surgical removal of the parathyroid glands is performed to remove them if they are producing too much hormone (hyperparathyroidism) or rarely to treat a parathyroid carcinoma (cancer). The operation is called a parathyroidectomy and may involve the removal of one gland (Single Gland Parathyroidectomy) or of all 4 glands (Total Parathyroidectomy) or sometimes 3 ½ glands (Subtotal Parathyroidectomy).

The most common operation is a single gland parathyroidectomy and often this can be performed as a minimally invasive procedure. It is usually carried out under general anaesthetic and here at My ENT Specialist we routinely use intra-operative laryngeal nerve monitoring.

Goitres and Nodules | My ENT Specialist

The surgery is carried out through a small cut or incision in the skin in the lower part of the neck. Depending on the preoperative scans it may be possible to go straight to the the enlarged gland and simply remove or it may be necessary to explore and identify all 4 glands to find the enlarged gland or adenoma. This takes a little longer as often we will confirm the glands location with a biopsy and wait for confirmation before proceeding.

Most operations can be performed as day surgery. (NB. Not for Renal Patients). Generally, we prefer not to use drains following parathyroid surgery and your wound will be covered with a waterproof dressing

After your surgery

  • Neck Incision - You will have a small wound around 2-3cm long in the lower part of the neck. This is generally closed with dissolving stitches and should be covered with a waterproof dressing for the first week.
  • Drains - This is a thin plastic tube that takes away blood and fluids from the wound. Many patients will not need a drain.
  • Discomfort - Most patients do not find parathyroidectomy particularly painful but some swelling and bruising in the week or two after an operation is normal this can be managed with mild painkillers such as Ibuprofen and or Panadol.
  • Calcium Levels - The parathyroid glands make a hormone called parathyroid hormone or PTH, which controls the amount of calcium in your bloodstream. Generally, one of the glands makes too much PTH which can raise the blood calcium. After we remove the overactive gland rarely and usually temporarily you can develop symptoms of low calcium. If this happens, we may need to give you extra calcium tablets for a few weeks.

The symptoms of low calcium are tingling or numbness in your fingers, toes and lips and cramps and spasms of your toes and fingers. If you develop any of these symptoms you should take three caltrate tablets immediately. If the symptoms do not settle within 30 minutes you should attend your nearest Emergency Department. If the symptoms settle, then increase your caltrate dose to 3 tablets three times daily and call the rooms for advice.

  • Voice changes - It is common for the voice to be a little croaky for the first few days following a parathyroid operation. This does not mean that the nerves supplying your voicebox have been damaged.

Complications of surgery

Parathyroidectomy is very safe but like all operations there are some complications such as:

  • Bruising bleeding and swelling – this is generally mild but in some cases can be more serious. If you develop any major swelling following your surgery please call the rooms for advice. Soft painless swelling is often the result of fluid accumulation called a seroma and can often be dealt with in the rooms.
  • Infections – infections following parathyroid surgery are extremely rare. However, if you develop a swollen or discharging wound or increasing pain in your neck you should call us.
  • Low calcium levels – see above
  • Recurrent laryngeal nerve injury – in expert hands there is an extremely low risk of damage to the nerves that move your voicebox. 1 in 100 patients undergoing parathyroidectomy can be affected but only one in a thousand have any symptoms of permanent voice problems. If both of the recurrent laryngeal nerves stop working then the voicebox cannot open for you to breathe. This would require a temporary tracheostomy or breathing tube. However, A/Prof McGuinness uses electrical vocal cord monitoring, which means that the risk of this happening is very low indeed.

If you develop any breathing difficulties following surgery call the rooms immediately or go to your nearest Emergency Department.

Thyroid Cancer Diagnosis | My ENT Specialist

Post Operative Care

  • Take your Caltrate if prescribed.
  • Post-operative blood tests – you will need a blood test to check on your calcium and PTH two days before your review appointment. The hospital should give you the forms for this. If they do not, please call the rooms.
  • Postoperative review – this is generally made for two weeks following the surgery. Our nurse will call you to see how you are progressing and also to make you an appointment. If you have not heard from us within five days, please call the rooms.