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PatientInformationLeafletP1

ParathyroidOperationsinAdults

WhataretheParathyroidglandsandwhatdotheydo?Usually,youhavefourparathyroidglands.Thesearelocatedbetweenthethyroidglandandthewindpipe,twooneachside.Inhealthyadults,eachparathyroidglandisusually3-4mminsize.Theyareresponsibleforthesecretionofahormone(theparathyroidhormone,PTH)whichisrequiredfortheregulationofcalciuminthebody.

RecurrentLaryngealnerve‘Voicenerve’

Thyroidgland

Parathyroidglands

Clavicle‘Collarbone’

Sternum‘Breastbone’

SuperiorLaryngealnerve

Larynx’Adam’sapple’

ReasonswhypatientsmayneedparathyroidsurgeryOnecommoncauseofhighcalciuminthebodyisduetoanabnormalparathyroidglandwhichis‘over-functioning’andproducingtoomuchPTH.Inthemajorityofpatients,thisisduetoasingleabnormalparathyroidgland(PrimaryHyperparathyroidism).Insomeinstances,morethanoneglandisinvolved.

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PTHactsonthekidneys,boneandgastrointestinaltract(stomachandbowel)toincreasethecalciumintheblood.Althoughhighcalciummaybeassociatedwithsymptoms,manypatientshavetheirhighcalciumdetectedcoincidentallyonroutinebloodtests.Symptomsthatmaybeassociatedwithhighcalciumcaninclude:

• muscleweaknessandfatigue• changesinyourheartrate• weightloss• excessivethirst• changesinurinaryfrequency• dehydration• stomachulcers• kidneystones• fractures

Eveninpatientswhodonothavesymptomsduetohighcalcium,parathyroidsurgeryisrecommended,assurgerydecreasesthelong-termeffectsonthebonesandkidneys.Whatarethealternativestosurgery?Medicationdoesexisttocontrolthehighcalciumintheblood.Youmayalreadyhavediscussedtheseoptionswithyourendocrinologistpriortoreferraltothesurgicalclinic.Medicaltreatmentisgenerallyoftemporarybenefit,anddoesnotaddresstheunderlyingproblemoftheoveractiveparathyroidgland.WhattestswouldIexpecttohavebeforesurgery?Priortoreferraltothesurgicalclinic,bloodandurinetestsarelikelytohavebeenperformedbyyourendocrinologist.Inadditiontothis,allpatientswouldneedtohaveanultrasoundscanoftheneckandkidneys.AspecializedscancalledtheSestamibiscanwouldalsoberequiredinthemajorityofcircumstances.Fortheminorityofpatients,aCTscanoranMRIscanmayberequired.WhattypeofparathyroidoperationsshouldIexpect?Theoperationisperformedunderageneralanaestheticsoyouarecompletely‘asleep’.

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Therearegenerally2approachestoparathyroidsurgeryOpenOperationAlsocalledcervicalexplorationorbilateralneckexploration.Thesurgeonwillmakeasmallincision(5to7cmor2to3inches)inyourneckinordertoperformthesurgery.Theadvantageofthistypeofsurgerywouldbetoensurethatallfourparathyroidglandsareinspected,andthediseasedglandisremoved.FocusedOperationAlsoknownasminimallyinvasiveapproachorkeyholeapproach.Theuseofthepreoperativescanshasallowedmoreaccurateidentificationofthediseasedparathyroidglandinsomepatients.Thus,inthesepatientsasmallerscarcanbeused.Onlytheglandidentifiedtobediseasedonthescan(s)isremoved.Yoursurgeonwillexplainwhichoneyouareadvisedtoconsiderandwhy.Inbothcases,thewoundisthenstitchedwithdissolvingstitchesorremovablestitches.Itwillhealtoformascar.Whatwillhappenpriortosurgery?Ifyouareonregularmedications,youshouldcontinuetheseunlessadvisedotherwise.Somesurgeonsmayaskyoutostoptakingmedicinessuchasaspirin,dipyridamole(Persantine)orclopidogrel(Plavix)inthedaysleadinguptoyouroperation.Ifyouareonanyofthesetablets,discussthiswithyoursurgeon.Patientsonblood-thinningtablets(suchaswarfarin,rivaroxabanordabigatran)shouldinformtheirsurgeon.HowlongwillIbeinhospital?Thisdependsverymuchonwhatprocedureyouhadandthehospital’slocalpolicies.Yoursurgeonwilladviseyouaccordingly.CareofyourwoundWhenyouaredischargedfromhospitalyoucanexpecttobegivenadviceaboutcareofyourwoundfromthewardstaff.Thewoundmaybecoveredbyadressingandthiscanusuallyberemovedafter48hoursunlessyouaretold

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otherwise.Youwillusuallybeabletotakeabathorshower48hoursafteryouroperation.Gentlypatyourwounddryratherthanrubit.Yourwoundmaybeslightlyraisedandpinkorredinthedaysfollowingsurgery.Thiswillsettleovertimeasitheals.Eventuallythewoundshouldbecomeflatandpalebutthismaytakeseveralmonths.Unlesssuggestedbyyourmedicalteam,itisnotadvisabletorubanyointmentsorbio-oilsontothewoundimmediatelyafteryoursurgerybeforethewoundhashadchancetoheal.Itisbesttowaituntilyouhavebeenseeninthepost-operativeclinicanddiscusswithyoursurgeonifyouwishtousesuchproducts.WhatcanIexpectaftertheoperation,andhowsoonwillIrecover?Itisnormaltofeeltiredfollowingparathyroidsurgery.Thesymptomsoftirednessthatyoumayhavehadpre-operativelymaytakeafewweekstoresolve.Insomecases,followingparathyroidsurgery,thelevelsofcalciuminyourbloodcanfalltoolow.Thisiswhilethebodyregainscontrolofcalciumbalanceinyourbloodstream.Yoursurgicalteamwillcheckforthisonpostoperativebloodtestsandyoumaybeprescribedcalciumtabletsshouldtheselevelsfalltoolow.Ifyoufeeltinglingorspasmsinyourlips,fingersortoes,contactyourGPasthiscanbeasignthatyourbloodcalciummayhavefallentoolow.Followinganeckexploration,youshouldbeabletoeatanddrinknormally,butsomepatientsfeelasthoughthereisalumpintheirthroatastheyswallow.Thisiscommonandwilldisappearintime.Beforeresumingdrivingyouneedtoensurethatyoucanmakeanemergencystopwithouthurtingyourneck.Youalsoneedtobeabletocomfortablyturnyournecktolookaroundasyoudrive,forexample,whenyouchangelanes.Youshouldinformyourcarinsurancecompanythatyouhavehadaparathyroidoperationasdifferentinsurersmayhavetheirownrulesabouthowlongyoushouldwaitafteranoperationbeforeyoureturntodriving.Yourreturntoworkdependsonthetypeofworkyoudoandtheoperationyouhavehad.Youmaybeabletoreturntooffice-basedworkaftertwotothreeweeksandheavierworkafterfourweeks.Yoursurgicalteamwilladviseyou.

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Whatarethepossiblecomplicationsofparathyroidsurgery?Complicationsofparathyroidsurgeryareuncommon.Thevastmajorityofpatientshavestraightforwardsurgeryandaredischargedthefollowingdaywithoutanycomplications.Yoursurgeonwilldiscussthebenefitsandpotentialcomplicationsofsurgerywithyouindetail.Pleasefeelfreetoaskanyquestionsthatareonyourmind.BAETShaveproducedapatientinformationleaflet,PotentialConsequencesofParathyroidSurgery,whichcanbefoundonourwebsite(www.baets.org.uk).

BAETSwishestoacknowledgetheadviceandsupportofHypoparaUK,apatient

supportgroupthatsupportspatientswhohavepostoperativeparathyroid

problems.

ForfurtherinformationandsupportpleasevisitHypoparaUKat

www.hypopara.org.ukorcall01342316315/01623750330

Disclaimer

Theadviceinthisleafletisbelievedtobetrueandaccurateatthetimeofgoingtopress.

Ultimately,theresponsibilityforobtaininginformedconsentfromyouforasurgicalprocedure

lieswithyoursurgicalteamandnotwiththeBritishAssociationofEndocrine&Thyroid

Surgeons(BAETS).

BAETScannotacceptanylegalresponsibilityforthecontentsofthisleafletwhichisproducedin

goodfaith.