Patient Guide to Parathyroid Surgery

Surgery Overview
Depending on the diagnosis and localization testing, one of three surgical approaches is selected to treat hyperparathyroidism. For all patients we identify the least invasive procedure expected to achieve a cure. 

  • One-gland exploration — Also known as minimally invasive parathyroid surgery, this procedure involves the isolated surgical removal of one gland. The advantages of one-gland exploration include a shorter operation, smaller incision and less overall trauma to the neck. A possible disadvantage, however, is that the three remaining glands are not similarly observed.
  • One-side exploration — A potentially more thorough but more invasive option is to surgically examine a full side, removing the enlarged parathyroid plus visualizing a second parathyroid.
  • Total parathyroid exploration — In cases where testing has shown enlarged glands on both sides of the neck and/or there is a strong family history of the disorder, all four glands are explored.   

Parathyroid surgery is performed under general anesthesia, sometimes requiring a one-night hospital stay. In some cases patients may go home the same day. You will meet with your anesthesiologist prior to surgery and on the day of the procedure to address any questions or concerns. A blood test will be scheduled the morning after surgery to determine your calcium and PTH levels.

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One Week Before Surgery

  1. Minimize taking aspirin-containing compounds, including these products: Excedrin, Alka-Seltzer, Advil (Ibuprofen) and most cold remedies.
  2. Visit the lab for preoperative tests and the Preanesthesia Assessment Clinic as scheduled by your surgeon.
  3. A postoperative exam will be scheduled with your surgeon. Calcium and PTH levels will be checked one hour prior to that visit.
  4. If you have received a prescription for pain medication, please have it filled and bring it with you on the day of surgery.
  5. Purchase Tums (calcium carbonate) 500 milligram tablets to have on hand following your surgery.

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One Day Before Surgery

  1. Call your surgeon's office at (206) 341-0040 between 1 and 5 p.m. to find out your morning check-in time.
  2. Shower with an antibacterial soap (e.g., Dial, Lever 2000) the night before and the morning of your surgery.
  3. Do not eat solid foods after midnight the night before your surgery. After midnight, consume no more than 16 ounces (two cups) of clear liquid, up to two hours before check-in. Clear liquids include water, apple juice, black coffee, tea, carbonated beverages and plain Jell-O. No milk products, alcohol, fruit juices with pulp, chewing gum or tobacco are permitted.

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After Surgery

  • Daily activities — You may resume normal daily activities when you feel ready.
  • Returning to work — Most patients are able to return to work within a few days after the surgery.
  • Driving — You will be able to drive a few days after you leave the hospital. Do not drive if you are taking pain medication.
  • Diet — For the first few days, try soft, soluble foods to keep swallowing easy (any swallowing difficulty is usually mild and lasts just a few days). Emphasize fresh fruits, vegetables, bran and liquids to help prevent any constipation that can result from taking pain medication.
  • Calcium supplements — Your doctor will instruct you about taking calcium supplements. Generally, if the serum calcium is normal or low on the first postoperative day, you will be advised to take one Tums tablet (500 milligrams) four times a day until rechecked at your follow-up appointment. In patients who show decreased bone density, calcium supplements may be continued long term.
  • Wound care — Your incision may be swollen (sometimes appearing "black and blue") and will be covered with sterile tape strips that act like stitches. You may shower with the tape strips in place. Remove the strips when they start to curl and come off, usually 10 to 14 days after surgery. Any minor pain at the incision site should decrease over time. While you may apply lotion or cream to the incision after the tape strips are removed, try to avoid exposing the site to excessive sunlight for up to one year after surgery.
  • Follow-up visits — Prior to surgery a follow-up visit will be scheduled with your surgeon. You will be supplied with a lab test form to complete your postoperative blood work. Please bring the form to the laboratory, on Level 6 of the Buck Pavilion, one hour before your appointment.
  • DEXA Scans — Patients showing low bone density should have DEXA scans on an annual basis.
  • Surveillance — Although recurrent hyperparathyroidism is very rare, your serum calcium and PTH levels should be checked during future routine exams. Please have your doctor forward results to Virginia Mason, Department of Surgery, P.O. Box 900, M.S. C6-SUR, Seattle, WA 98111.

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Surgery Risks
Complications during or following parathyroid surgery are rare. Possible risks associated with the surgery include:

  • Infection — Infection at the surgery site is very rare. Signs of infection should be immediately reported to your doctor and can include increasing pain, fever and discharge from the wound.
  • Postoperative bleeding — While uncommon, any signs of bleeding are carefully monitored in the recovery room and overnight to ensure swelling is controlled and there are no other complications.
  • Nerve dysfunction — Great care is taken during the procedure to protect the recurrent laryngeal nerve (the nerve to the vocal cord). About the thickness of a strand of hair, the laryngeal nerve is located behind the thyroid, close to the parathyroid glands. Although it is rare that parathyroid surgery results in injury to the recurrent laryngeal nerve, the dysfunction will likely correct itself. If permanent injury were to occur, a secondary procedure is effective for treating hoarseness of the voice.
  • Hyperparathyroidism — Parathyroid surgery can cause hypoparathyroidism, meaning PTH and calcium levels are too low. This can be treated with calcium and vitamin D supplements.

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Contacting Your Doctor
If you have questions or problems, contact the surgery office at (206) 223-6629. The following symptoms are reasons to contact our office immediately:

  • Fever greater than 101º F (38.3º C)
  • Increased redness, swelling or drainage from your incision
  • Facial twitching, numbness or tingling or muscle cramps not relieved by calcium supplements

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