Mr ENYI OFO
Consultant ENT, Head & Neck, Thyroid and Parathyroid Surgeon
BSc (Hons) MBBS (Lond) DO-HNS FRCS (ORL-NHS) PhD
WHAT IS THE PARATHYROID GLAND?
The parathyroid glands are four small glands situated behind the thyroid gland at the base of the neck. They produce the parathyroid hormone (PTH), which controls the level of calcium in the blood. Each gland is similar in size to a grain of rice. Adequate control of blood calcium levels is important for the proper functioning of the heart, muscles, brain, kidneys, bowels, and the maintenance of healthy bones.
Parathyroidectomy is an operation to remove one or more parathyroid glands, mainly because they are producing too much parathyroid hormone (PTH).
REASONS WHY PARATHYROID SURGERY MAY BE INDICATED
An overactive parathyroid gland producing too much parathyroid hormone is the main reason why parathyroid surgery will be required. The most common medical condition causing this is primary hyperparathyroidism (PHPT). Most cases of PHPT are due to a single parathyroid which has been become enlarged, i.e. parathyroid adenoma, and secretes too much PTH into the blood, which consequently causes the body to produce too much calcium. In younger patients (under 40 years of age) PHPT may be due to a genetic condition, hence genetic tests to exclude some rare syndromes may be required. Long term, high levels of calcium in the blood is not good because of the damage it causes to the kidneys, bones, and heart amongst other body organs.
SYMPTOMS OF AN OVERACTIVE PARATHYROID GLAND
If one or more of your parathyroid glands is overactive it may lead to a raised blood calcium level and cause one or more of the following symptoms:
feeling more tired and sleepy
muscles may feel weak or tender
passing urine more frequently and constipation
you are more likely to form kidney stones
Feeling nervous or low in mood.
However, a significant number of patients may not have any symptoms at all, and the high blood calcium level would have been detected following a routine blood test.
PARATHYROID SURGERY (PARATHYROIDECTOMY)
Parathyroidectomy is performed under a general anaesthetic and can last between 30 to 90 minutes depending on the extent of surgery. A small horizontal, midline incision is made in one of the skin creases of the lower neck. The scar normally heals very well. Although the scar is in a visible area, the vast majority become significantly less obvious over time, and most patients following parathyroidectomy do not report that the neck scar causes them a problem or embarrassment.
Recovery from the operation is usually fast, with patients out of bed soon after surgery and discharged home the next day.
Following surgery, blood tests are required to monitor the level of calcium in the blood, as it is expected in some patients for the level to be low after surgery. You may be required to take oral calcium/vitamin D supplements, usually in tablet form, to maintain the calcium levels in your blood.
COMPLICATIONS OF PARATHYROID SURGERY
As with all surgery, complications although rare can arise and may include the following;
· Failure to find the enlarged/overactive parathyroid gland
· Nerve damage
· Voice changes
· Neck scar issues
· Low blood calcium levels
Surgical site infection
AFTER THE PROCEDURE
Patients usually go home the day after parathyroid surgery. As soon as you recover from the anaesthetic you will be encouraged to eat and drink, mobilise and self-care as normal. Overnight observation is done to ensure that there are no immediate complications from surgery such as bleeding or dangerously low calcium levels.
RETURNING HOME POST SURGERY
Parathyroid surgery is a major operation therefore you should rest for 2 to 3 days when you return home. You will normally be well enough to return to work in 1 to 2 weeks’ time, but this will vary depending on the type of work you do. It is normal to feel tired for the first few weeks.
The surgical incision site should be kept dry for at least the first 3 days, and it can be left alone for up to two weeks underneath a sterile waterproof dressing. You are most likely to have dissolvable stitches which do not need to be removed. When your neck incision is healed after the first 1 to 2 weeks it can be gently massaged regularly at least twice a day with a cream (e.g. vitamin E cream) to soften the scarring.
You may be asked to have a blood test either at your follow up appointment or with your GP, this is to check whether your parathyroid glands have been affected by the operation.
If there are any concerns about the neck scar or if it becomes red, hot, swollen or painful, you should seek medical advice.
You can drive as soon as you are physically able to and are not impaired by pain medication.