Parathyroid Gland Removal (Parathyroidectomy)

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KEY POINTS

• A parathyroidectomy is surgery to remove 1 or all of your 4 parathyroid glands. They make a hormone that helps control the levels of calcium and phosphorus in the blood.
• Every procedure or treatment has risks. Ask your healthcare provider which risks apply to you.
• Ask your provider when you can return to your normal activities and how to take care of yourself at home.

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What is a parathyroidectomy?

A parathyroidectomy is surgery to remove part or all of your parathyroid glands.

Usually you have 4 parathyroid glands in your neck. They make parathyroid hormone (PTH), which helps control the levels of calcium and phosphorus in the blood. Abnormal growth or overactivity of these glands may increase the amount of parathyroid hormone in your body. An increase in the hormone level can change the amount of calcium and phosphorus in your body. As a result, your bones may get weak. You may also have kidney stones, weakness in your muscles, decreased alertness, depression, or stomach pain. Removal of the overactive gland or glands can help stop these problems.

When is it used?

Your healthcare provider may recommend removing part or all of your parathyroid glands if:

• You have abnormal growth of some or all of the glands.
• One or more of the glands are overactive.

If your glands are only mildly overactive and you don’t have any symptoms, your healthcare provider may recommend that you have surgery only if you start having problems.

Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Make plans for your care and recovery after you have the procedure. Find someone to give you a ride home after the procedure. Allow for time to rest and try to find other people to help with your day-to-day tasks while you recover.
• Follow your provider's instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly. It is best to quit 6 to 8 weeks before surgery.
• You may or may not need to take your regular medicines the day of the procedure. Tell your healthcare provider about all medicines and supplements that you take. Some products may increase your risk of side effects. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• Tell your healthcare provider if you have any food, medicine, or other allergies such as latex.
• Your provider will tell you when to stop eating and drinking before the procedure. This helps to keep you from vomiting during the procedure.
• Follow any other instructions your healthcare provider gives you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do. You have the right to make decisions about your healthcare and to give permission for any tests or procedures.

What happens during the procedure?

This procedure will be done at the hospital or a surgery center.

You will be given general anesthesia to keep you from feeling pain during the procedure. General anesthesia relaxes your muscles and puts you into a deep sleep.

A nuclear scan is done in the X-ray department about 2 hours before the operation. If an abnormal gland is found with the scan, your healthcare provider will make a small cut and remove the abnormal gland. Your provider will then close the cut. This procedure is called a minimally invasive parathyroidectomy.

If no site can be identified by the scan, your provider will make a larger cut in your neck and remove glands or parts of glands that appear abnormal. He or she will then sew the cut closed.

Sometimes all of the glands are overactive. In this case about three and a half of the four glands may be removed. Or your healthcare provider may remove all of the glands and put very tiny pieces of one of the glands in a muscle in your arm or neck so that you keep having some parathyroid function. A small metal clip is put in the same area so your provider can find the pieces of gland if the gland tissue becomes overactive again and needs treatment. Sometimes your provider may use video or endoscope assistance to do the surgery.

The procedure may take one to several hours, depending on how hard it is for your provider to find the parathyroid glands.

What happens after the procedure?

If you have just a small cut, you may be able to go home the same day. If you have a larger cut, you may be in the hospital for about 1 or 2 days, depending on your condition.

You may have some swelling in your neck and find that you have a sore throat and slight hoarseness. Your neck may tire out very easily for a while, making it hard to hold up your head. You may need to take calcium to avoid having spasms in the muscles. You will have a scar in the front of your neck just above the breastbone.

Ask your healthcare provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

What are the risks of this procedure?

Every procedure or treatment has risks. Some possible risks of this procedure include:

• You may have problems with anesthesia.
• You may have infection or bleeding.
• Other parts of your body may be injured during the procedure.
• You may have weakness and muscle cramps because your blood doesn’t have enough calcium. If this happens, you will be given calcium to relieve the symptoms.

Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.