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Parathyroid Surgery at Johns Hopkins

Hyperparathyroidism can be cured with surgery. The purpose of parathyroid surgery is to locate and remove the abnormal parathyroid gland(s). When performed by an experienced endocrine surgeon, the operation is successful in approximately 95% of cases. Complications can occur, but are uncommon. Rarely, all four parathyroid glands need to be removed and sometimes, a portion of one is transplanted into the forearm. The hospital stay for these cases may be more than one night depending on the calcium level after surgery. Your surgeon will explain your specific surgery and why it is recommended in your case.

As with any surgical procedure, there are risks involved. There is a risk of bleeding, but this is very low.  The average blood loss is less than an ounce. The risk of infection is so low that antibiotics are not routinely used. There is also a very low risk of injury to the recurrent laryngeal nerves which control the vocal cords. Injury to these nerves could affect your voice. There is also the possibility that the abnormal glands could not be located or that your symptoms may reoccur over time. Occasionally, hypoparathyroidism may result after surgery. This is associated with low calcium levels and may require calcium and vitamin D supplements to maintain normal calcium levels. There is also a small risk associated with anesthesia. The overall risk of complications is low, however, and is usually outweighed by the benefits of surgery. Your surgeon will go over this information with you and answer your questions.

Before Your Appointment

Our physicians want to make sure we are prepared for your visit and therefore, before we can schedule an appointment, we will need you to provide us with the following:

  • Calcium number/inact parathyroid hormone (PTH) report 
  • Creatinine blood test results, if available
  • Ultrasound images (on CD) and report, if available
  • Vitamin D test results, , if available
  • Sestamibi scan and report, if done at The Johns Hopkins Hospital

Before Surgery

Once the surgery has been scheduled, arrangements will be made for your pre-operative evaluation. You will meet with a nurse practitioner or physician’s assistant from the anesthesiology department. The pre-op exam may include laboratory work, chest X-ray and an EKG. This will be done at the Johns Hopkins Outpatient Center and will be scheduled by your surgeon’s secretary. 

If you take aspirin or nonsteroidal anti-inflammatory agents you should stop taking these one week before surgery. The night before surgery, do not have anything to eat or drink after midnight. Get a good night’s sleep.

The Day of Surgery

Your doctor’s secretary will let you know where your surgery will be and what time you need to arrive at the hospital on the day of surgery. It is very important to arrive at least 2 hours before surgery. During the surgery, your family can wait in the family waiting area. They will be kept updated by the patient representative and operating room staff. The surgeon will speak with them after surgery has been completed.

What will happen in surgery?

You will be given general anesthesia to put you to sleep. You are positioned with special pillows under your neck to tilt your head back. An incision is made at the base of your neck and is about two to four inches long, depending on the exact type of operation you have. Using magnifying lenses, the surgeon locates the parathyroid glands and the abnormal one(s) are removed. The incision is stitched closed and is then covered with steri-strips (tapes) and a dry gauze dressing.

The operation generally lasts from 1 to 3 hours. After surgery, you will stay in the recovery room for several hours. Depending on the exact type of surgery you have you will either be discharged home on the same day of surgery or be admitted for one night’s stay.

After Surgery

If you are admitted to the hospital, you will have a liquid diet for dinner. You may have a sore throat. The nurse will provide lozenges and/or throat spray to help relieve this. If you need something for pain, the nurse will give you a liquid pain medicine. You will have a dressing on your neck which will be removed in the morning. The head of your bed will be raised to decrease swelling. You will have an intravenous line to give you fluids until the next day.  Your calcium level will be checked by a blood test in the morning. You will be offered regular food the next morning. Most people are ready to go home after breakfast.

You will also be given instructions about taking calcium supplements and possibly Vitamin D (Rocaltrol).

Same Day Surgery

If you are discharged on the day of surgery you will have plastic dressing over your incision. You may shower on the night of surgery, but keep the dressing as dry as possible. Two days after surgery, remove the plastic dressing and gauze. There will be tapes (steri-strips) underneath. Leave these in place. Your diet may consist of liquids and soft foods, depending upon which feels better to you, since your throat will be sore.

The Incision

After the dressing is removed, you will notice that it is covered with tapes (steri-strips). These will stay on for about a week. Leave the steri strips in place. You may shower. Try to keep the neck area as dry as possible and pat dry after showering. The stitches will be removed in the office about a week and a half after surgery. Infection is extremely rare.

If you notice any redness or drainage from the incision, contact your surgeon. After the stitches are removed, the most important thing you can do to improve the appearance of your scar is to protect it with sunscreen that has a sun protection factor (SPF) of 30 for an entire year. During the year your scar may become raised or red, but will almost always fade into a thin line which will be less noticeable.

How will I feel after surgery?

Everyone is different. You will most likely be a bit sore for a few days. You may have pain, not only from your incision but also from muscle soreness in your upper back and shoulders. This is from the positioning in the operating room during the surgery. You will have liquid pain medicine in the hospital and a prescription for pain pills to take at home.

You may have a sore throat. This is a result of the placement of anesthesia tubes during surgery. Throat lozenges and spray usually help. Your neck may be slightly swollen as well. You may feel like you have a lump in your throat when you swallow. This will improve after a few days but may continue for a week or so. If you notice sudden neck swelling contact your surgeon’s office.

Your calcium level may drop after surgery. If you experience numbness or tingling around your mouth or in your fingertips (within 24-48 hours generally), take calcium supplements (about 1200 mg) every four hours for these symptoms and until the symptoms resolve. Once the symptoms have resolved, discontinue the calcium supplement. Should they reoccur, begin taking the calcium supplement again. If you have any questions, please contact your surgeon.

Recovering at Home

Most people take 1 to 2 weeks off to recover. You should not drive for at least a week. You are likely to note improvements in the symptoms you may have had from high calcium levels. Everyone is different, however. Let your surgeon know about your symptoms and any changes you notice.

 

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