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 patients who think they have no symptoms often realize they feel much better, with better sleep and improved energy after they are cured. If you don't have surgery, you will continue to have high blood calcium, and potential symptoms. Without surgery, there is strong evidence your bones are more likely to weaken and 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?
You will be admitted on the day of surgery, and discharged the next morning. If you are very keen, and live in the area, you can go home the day of surgery.
What type of anaesthesia will I have?
You will have a general anaesthesia. You will be completely asleep during the operation. You will have local anaesthesia injected into the neck (cervical plexus block) to make you even more comfortable when you wake up. This local anaesthetic block will probably leave your ear lobes numb for 24 hours as well.
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 slightly 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.
Beginning five days after the operation, massage the scar for five minutes when you wake up, five minutes in the middle of the day, and another five minutes when you go to bed. There is good evidence that wound massage reduces pain and improves healing. Turn your head and roll your shoulders several times daily to avoid stiffness.
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.
In patients prone to keloids, I use skin glue rather than sutures. The glue eventually flakes off by itself.
For parathyroid “mini-surgery,” the scar is about 1-1 1/2 inches (2.5-3.5cm). If you need a full neck exploration, it will be bigger (5-6cm). 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 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 or two 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. If you are a singer, you may find difficulty hitting the higher notes. Some people have trouble with voice fatigue. These changes are usually, but not always, temporary.
Sometimes the surgery will not cure the hyperparathyroidism. In the hands of an experienced endocrine surgeon, failure to cure occurs in around 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 - < ½ % (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 - uncommon in Caucasians, 10-15% in Asians, Indians, Africans.
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.