Parathyroid Surgery Part 3: Evaluation, Surgery, Recovery

To learn more about your condition, your doctor will evaluate you. A thorough medial history is taken and you are examined. Some tests may also be done. This evaluation gives your doctor information needed to plan your surgery.

Medical History and Physical Exam

During the medical history, you’ll be asked about your risk factors and symptoms. Be sure to describe any symptoms you have, even if they seem minor. Also mention other medical problems you have or have had in the past. You may be asked about the foods you eat and medications you take. During the physical exam, you doctor will check you head and neck. Other parts of they body may also be examined to rule out other conditions.

Diagnostic Tests

Certain tests are done to check for hyperparathyroidism and the risk of related health problems, such as kidney and bone disease. Tests may include:

  • Blood tests. Samples of blood are drawn from a vein. These are checked for high levels of calcium and PTH. The levels of vitamin D, magnesium, alkaline phosphatase, and phosphorus may also be checked.
  • Urine tests. Samples of urine are taken over a 24-hour period. These are checked for high levels of calcium and problems with the kidneys.
  • Bone density study. Scans of the hip, lower back, or forearm are taken. This test measures the amount of calcium in the bones to check bone health.

Imaging Tests

Imaging tests may be done to help the doctor find the parathyroid glands and see which are enlarged. Each test is usually performed by a doctor or a trained technologist. In some cases, enlarged parathyroid glands can’t be seen on imaging tests.

A sestamibi scan is used to find any enlarged parathyroid glands. The test can take up to 3 to 4 hours. During the test, a safe radioactive fluid is injected into the veins. This fluid helps make enlarged parathyroid glands show up clearly when a special camera is used.

An ultrasound can also be used to find enlarged parathyroid glands. Normal glands are too small to be seen, but enlarged parathyroid glands show up clearly when a special camera is used.

A CT (computed tomography) scan combines x-rays and computer processing technology to form pictures. An MRI (magnetic resonance imaging) scan uses magnets and radio waves to form pictures. These tests are done less often, but they can also be used to locate enlarged parathyroid glands.

Your Surgery

Enlarged parathyroid glands are removed with surgery. Your doctor can tell you more about this surgery and what to expect. Once you and your doctor schedule surgery, you’ll be told how to prepare. Follow all instructions. Also, be sure to ask any questions you have.

Preparing for Surgery

To prepare for surgery, you may need to:

  • Have various tests to make sure you’re healthy enough for surgery.
  • Tell your doctor of any medications you’re taking, including vitamins and supplements. You may need to stop taking certain medications, such as aspirin or ibuprofen, a week or two before surgery.
  • Have nothing to eat or drink for 6 to 8 hours before surgery. The doctor will give you specific instructions in advance.
  • Arrange for an adult family member or friend to give you a ride home from surgery.

The Day of Surgery

Arrive for surgery on time. Before going to surgery:

  • You’ll need to register. This may be done ahead of time during an earlier visit, online, or over the phone. Be prepared to fill out forms. Have identification and insurance information ready.
  • You’ll change into a hospital gown.
  • An IV (intravenous)line will be placed in a vein in your arm or hand. This is used to give fluids and medications.
  • Medications used to keep you free from pain during surgery is called anesthesia. Before surgery, an anesthesiologist or nurse anesthetist (doctor or nurse trained to give anesthesia) will discuss with you what type you’ll receive.

During Surgery 

You may need one or more parathyroid glands removed. The decision about how many glands to remove is often made during surgery. Be sure to ask your doctor for more information, if you have specific questions.

Removing the Glands

  • An incision is made in the neck.
  • The enlarged parathyroid gland or glands are found and removed. This should return the level of calcium in the blood to normal.
  • In some cases, all four glands are enlarged. When this happens, three and a half of the glands may be removed. The remaining half gland often makes enough hormone to replace four normal glands, In rare cases all of the glands are removed. Parts of one gland are then placed in another location in the body, usually in the neck or arm. This is called a parathyroid autotransplantation. The moved gland continues to work from this new location.
  • When surgery is complete, the incision is closed with sutures (stitches), strips of surgical tape, or surgical glue.

Risk and Complications

Your doctor will discuss the risks and possible complications of surgery with you. These include:

  • Injury to laryngeal nerves
  • Failure to locate the enlarged gland or glands, requiring more surgery
  • Bleeding
  • Infection
  • Reaction to anesthesia
  • Thyroid gland complications

Your Recovery 

Recovery from parathyroid surgery is usually quick. You may go home on the day of surgery or you may need to stay overnight. Once you’re ready to go home, you’ll be given instructions for how to care for yourself. Follow these instructions carefully. See your doctor for follow up visits to be sure your recovery goes smoothly.

Right After Surgery

You can expect the following after surgery:

  • You’ll be taken to a recovery area to rest. Here, your blood pressure, heart rate, and breathing are carefully monitored.
  • Your incision may be covered with a dressing or bandage. The incision site is checked often for bleeding or other problems.
  • You’ll receive pain medication as needed to keep you comfortable.
  • You’ll gradually be given food and drink.
  • Your blood calcium and PTH levels may be tested.

Taking Supplements

It will take time for your body to adjust after the removal of any parathyroid glands. To maintain a normal level of calcium in the blood, you may be told to start taking calcium supplements in the hospital. You’ll continue these at home for as long as needed. Your doctor may also prescribe vitamin D supplements. These can help your body absorb calcium. Take all supplements exactly as directed.

Recovery at Home

You may feel tired and have some soreness and stiffness in your neck. Also, a sore throat is common and may last for a few days after surgery. Take care of your incision and ease back into your normal routine as instructed by your doctor.

Caring for Your Incision

Proper care for your incision can speed healing. You may need to see your doctor after surgery to have any stitches removed. Be sure to keep your incision clean and dry. Check with your doctor first before applying any creams or ointments to the incision.

Easing Back into Activity

You can get back to your normal routine as soon as you feel comfortable. Walking is fine, but avoid any heavy lifting or strenuous exercise for a few weeks. Your doctor may advise you to wait a week before driving. Return to work when you feel ready. For most people, this takes at least a few days.

Follow-Up Care

Keep all follow-up appointments. Your doctor will discuss the surgery results with you and let you know when you’re fully recovered. Blood tsts are often done to check if your blood calcium lvel has returned to normal. If you had symptoms such as bone or kidney problems, these may be treated. Your doctor will give you more information, if needed. Your doctor may also recommend that you have your blood calcium level checked yearly.

When to Call Your Doctor

Call your doctor if you notice any of the following during your recovery:

  • Numbness or tingling in the fingertips or around the mouth
  • Muscle cramping or spasms
  • Neck swelling
  • Fever over 100.4 degrees F
  • Increasing redness, swelling, or drainage at the incision site
  • Nausea or vomiting
  • Hoarse voice that worsens
  • Trouble breathing
  • Trouble swallowing
  • Irregular heartbeat

Feeling Better 

Surgery can correct your parathyroid problem and help keep your body working normally. After surgery, you may notice that you feel more energetic and alert. If you have lost bone, the great news is that you can make up for lost ground. You can take steps to restore the calcium in your bones and keep them strong and healthy.