Parathyroid Surgery
What are the parathyroid glands?
The parathyroid glands are small glands located near or attached to the back of the thyroid gland. There are normally four parathyroid glands and they are usually no larger than a grain of rice. Parathyroid glands regulate the level of calcium in your body by regulating the secretion of PTH (parathyroid hormone).
What is parathyroid surgery?
Parathyroid surgery is an operation to remove one or all of the parathyroid glands. It is most commonly required if there is overactivty of the parathyroid glands (hyperparathyroidism).
What are the indications for parathyroid surgery?
Dr Graham will discuss your condition with you in details and discuss the different treatment options available. Parathyroid surgery is usually recommended for parathyroid conditions that include:
Parathyroid adenoma – a benign (non-cancerous) enlargement and hyperfunctioning of one of the parathyroid glands
Parathyroid hyperplasia – enlargement of one or more of the parathyroid glands due to an overgrowth of normal cells
Parathyroid cancer – this is rare and accounts for less than 1% of all cases of primary hyperparathyroidism
How is parathyroid surgery usually performed?
Thyroid surgery is almost always performed under a general anaesthetic. The type of surgery depends on the underlying problem and the results of your investigations before surgery.
Parathyroid surgery can be performed by two main approaches:
Minimally invasive parathyroidectomy: this surgery is appropriate if pre-operative scans and tests demonstrate the exact location of a single, abnormal parathyroid gland that is causing your hyperparathyroidism. A small incision is made on over the abnormal gland and one side of the neck is explored via this incision. In a small number of cases, a minimally invasive parathyroidectomy will need to be converted to an open parathyroidectomy if Dr Graham is not able to locate an enlarged parathyroid gland.
Open parathyroidectomy (Four gland exploration): an incision is made in the front of the neck that allows exploration of both sides of the neck. Dr Graham is able to visualise the thyroid gland and all four parathyroid glands in order to identify the abnormal gland or glands.
How long do I stay in hospital and what is the recovery like?
Following the surgery, you will be taken to the recovery ward and then to a post-operative ward and monitored carefully. You will be prescribed medication to help alleviate any pain you may have. You will be allowed to start eating and drinking soon after surgery. Most people stay in hospital for one night after the surgery. Occasionally, minimally invasive parathyroidectomy can be performed as a day only procedure.
Blood tests will be taken in recovery and then on the ward to ensure that your parathyroid and calcium levels are returning to normal.
You will be able to do most things to care for yourself after surgery and are encouraged to do so. You may shower as normal. You will need to avoid strenuous activities for at least 2 weeks and any heavy lifting or straining for 6 weeks.
What are the risks and complications of parathyroid gland surgery?
All operations have potential side effects and complications. Fortunately, these are uncommon and surgery usually proceeds without any problems. Dr Graham will the risks and possible complications with you in detail at your consultation.
Risks specific to parathyroid surgery include but are not limited to:
Bleeding – any visible bleeding is controlled during the surgery using a combination of blood vessel sealing devices and small metal clips. Sometimes, after surgery, vessels can reopen and bleeding can restart. A build-up of blood in the neck may cause obstruction of the airway and require urgent return to theatre to evacuate the blood. This is uncommon.
Hypoparathyroidism – injury to other parathyroid glands may cause low levels of calcium in the blood. This is treated with calcium and vitamin D tablets and is usually temporary.
Injury to nerves that supply the vocal cords – rarely, this important nerve may be damaged. This can result in a permanent hoarse voice, or difficulty with higher pitch of the voice. It can also significantly impact swallowing. It is common to have a temporary hoarse voice in the days after surgery. Most commonly changes in speech and swallowing are temporary and resolves. A speech therapist can help with exercises to improve the voice in this setting. If both of these nerves are damaged, severe breathing difficulty may occur and assistance with breathing may be required. Very rarely, this may be permanent.
Scarring - in some people, healing of the wound can become thickened, red and painful (a keloid scar).
Infection - infection of the wound after thyroid surgery is very uncommon. Symptoms include swelling, redness, heat and discharge from the wound. If it occurs, antibiotics and further treatment may be required.
Persistent hyperparathyroidism - even in expert hands, some parathyroid tumours cannot be found and calcium and parathyroid hormone levels remain elevated. Further tests and surgery may be required. Sometimes, after successful surgery, the other parathyroid glands can become overactive and cause calcium levels to become raised again (recurrent hyperparthyroidism).
Dr Graham advocates the National Law and Australian Health Practitioner Regulation Agency (AHPRA) guidelines that any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.