Dr. Julie Miller, Endocrine Specialist, Parkville Melbourne VIC
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FAQ's

Frequently Asked Questions - Parathyroid Surgery

Is there any other treatment for hyperparathyroidism besides surgery?

No. Surgery is the only effective treatment of hyperparathyroidism.

What if I don't have the surgery?

Even if you think you have no symptoms, you will probably feel much better after you are cured. If you don't have surgery, you will continue to have high blood calcium, and many symptoms. Without surgery, your bones will continue to become weaker, and possibly break. There is evidence of increased risk of high blood pressure, stroke, heart disease, and even shorter life expectancy, from untreated hyperparathyroidism.

How long will I be hospitalised?

Most patients are able to go home the same day (after parathyroid "mini-surgery") or the following day.

What type of anaesthesia will I have?

You will have a general anaesthesia . You will be completely asleep during the operation.

When will I know the results of the surgery?

The calcium levels generally return to normal within 12-48 hours of surgery.

Will I have a scar?

Yes. All surgeries cause scarring, and how a patient scars is dependent on the individual. However, there are some techniques that surgeons use to minimise scarring. These techniques include careful incision placement and hypoallergenic suture material (to avoid inflammation). For parathyroid "mini-surgery," the scar is about 1-2 inches. If you need a full neck exploration, it will be bigger. As a general rule, no matter which operation you need, it is unusual to have a very noticeable scar after six months. Scars continue to fade for three years.

Will I have pain after the operation?

All operations involve some discomfort, but most patients are surprised at how little pain they feel after this operation. Although you should be able to eat and drink normally, the main complaint is sore throat and discomfort with swallowing for 1-2 days. Most patients take Panadol or Nurofen to keep them comfortable at home. You will have a prescription for something stronger for the first few days in case you need it, but beware prescription pain medicine can make you drowsy and constipated, so do not drive, drink lots of water and eat plenty of fruits and vegetables.

Will I have stitches?

You will have stitches on the inside that dissolve on their own. You will have a waterproof Comfeel dressing so that you can shower or bathe as usual (but do not submerge the incision for 5 days). Leave the dressing in place until your first post-operative visit, where it will be removed. Do not be alarmed if a small “blood blister” is visible under the dressing. If present, it will come off when the dressing is removed.

Will I have any physical restrictions after my surgery?

Your activity level depends on the amount of discomfort you experience. Many patients have resumed golf or tennis within a week after the operation. Most patients return to work in a week, and you are able to drive as soon as your head can be turned comfortably without prescription pain pills (this limitation is for driver safety).

What are the possible complications of parathyroid surgery?

The nerves that control your voice are very closely associated with the parathyroid glands. Temporary voice changes are not uncommon, but usually resolve within weeks to months. In 1 in 100 parathyroid operations, the nerves that control the voice are permanently affected. When this occurs, the main difficulties are projection of the voice and production of high pitched sounds. It is usually described as hoarse, but will not necessarily be considered abnormal by strangers.

Sometimes the surgery will not cure the hyperparathyroidism. In the hands of an experienced endocrine surgeon, failure to cure occurs in fewer than 2 in 100 patients. Sometimes the normal parathyroid glands become "lazy" because the abnormal gland was doing all the work. They may take some time to recover, so some patients require extra calcium tablets on a temporary basis. Rarely, the parathyroids do not recover, and calcium and vitamin D may be needed on a permanent basis. In rare instances, the tumour can recur. Lifelong blood tests every one to two years is recommended.

There is a small risk of bleeding into the wound. If this happens, it may be necessary to have a second operation to evacuate the blood so it does not interfere with your breathing. Infection is relatively uncommon, and is easy to treat should it occur.

WHAT ARE THE RISKS OF PARATHYROID SURGERY?

As with anything in life, there are risks to surgery. These risks are weighed against the risks of not having surgery. Listed below are some of the possible complications of surgery. Risks include, but are not limited to:

  • Permanent voice hoarseness...........<1%
  • Failure to cure the hyperparathyroidism......<2%
  • Permanent hypoparathyroidism........< % (0% for mini-surgery)
  • Infection of Incision........................................... Less than 1%
  • Haematoma or Bleeding..................Less than 1%
  • Seroma (fluid collection)..........1% (temporary)
  • Swelling and black/blue....................................About 5% (temporary)
  • Keloid or overgrown scar.........rare

Other unforeseen risks

You will require general anaesthetic, given by a specialist anaesthetist. Risk of a serious complication in a healthy person is very rare. Potential risks include, but are not limited to:

  • Heart problems (death, heart attack, arrhythmias)
  • Lung problems (pneumonia, wheezing)
  • Blood clots (stroke, clots in leg veins or lungs)
  • Drug reactions (also possible with local anaesthetic)
  • Chipped teeth
  • Other unforeseen risks

You will meet the anaesthetist before your operation and have the chance to discuss these further.

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Dr. Julie Miller - Specialist Endocrine Surgeon
Dr. Julie Miller - Specialist Endocrine Surgeon
 

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