Parathyroid Operations in Adults

What are the Parathyroid glands and their functions?

Typically, individuals have four parathyroid glands situated between the thyroid gland and the windpipe, with two on each side. A small number of patients may have supernumerary parathyroid glands and occasionally the glands may be situated in an abnormal position like the top of the neck or the upper chest. In healthy adults, each parathyroid gland is typically 3-4 mm in size. These glands play a crucial role in secreting a hormone known as parathyroid hormone (PTH), essential for regulating calcium levels in the body.

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Indications for Parathyroid Surgery

A prevalent reason for elevated calcium levels in the body is an overactive parathyroid gland that excessively produces parathyroid hormone (PTH).

For most patients, this stems from a solitary abnormal parathyroid gland (adenoma), known as Primary Hyperparathyroidism. However, in certain cases, more than one gland may be implicated

PTH influences the kidneys, bones, and gastrointestinal tract (stomach and bowel), enhancing calcium levels in the bloodstream. While elevated calcium may present symptoms, many patients discover their high calcium levels incidentally through routine blood tests.

Potential symptoms associated with high calcium include:

• Muscle weakness and fatigue
• Changes in heart rate
• Weight loss
• Excessive thirst
• Changes in urinary frequency
• Dehydration
• Stomach ulcers
• Kidney stones
• Brittle bones - Fractures

Even for patients lacking symptoms related to high calcium, parathyroid surgery is recommended to mitigate the long-term impact on bones and kidneys.

What are the Non-Surgical Options?

There are medications available to manage elevated blood calcium levels. You may have already discussed these alternatives with your endocrinologist before being referred to the Mr. Jeddy. 

However, it's important to note that medical treatment typically offers temporary relief and does not address the underlying issue of the overactive parathyroid gland.

What Tests Are Conducted Before Surgery?

Before the referral to the surgical clinic, your endocrinologist likely conducted blood and urine tests. Additionally, all patients would have undergone a neck and kidney ultrasound. In most cases, a specialized Sestamibi scan is also necessary. However, for a minority of patients, a 4D-CT scan or an MRI scan may be required.

What Parathyroid Operations Should I Expect?

The operation is conducted under general anesthesia to ensure complete unconsciousness.

There are generally two approaches to parathyroid surgery:

1. Targeted Operation:

• Also known as the minimally invasive approach.
• Utilizing preoperative scans allows for more precise identification of the diseased parathyroid gland in most patients.
• In these cases, a smaller scar can be employed, and only the gland identified as diseased on the scan(s) is removed.

2. Four gland exploration:

• Also referred to as cervical exploration or bilateral neck exploration.
• This is usually performed when pre-operative tests do not indicate a single adenoma, and in patients who are undergoing Parathyroid surgery with chronic renal failure. 
• Mr. Jeddy makes a small incision (5 to 7 cm or 2 to 3 inches) in your neck for the procedure.
• This approach ensures a thorough inspection of all four parathyroid glands, with the removal of the diseased gland being a key advantage.

You will be guided on which approach is recommended for your specific case and be provided the rationale behind the recommendation. In both cases, the incision is closed with skin clips, which are removed before discharge from hospital the following day.

How long will I be in hospital?

Most patients operated upon by Mr. Jeddy are discharged the following day. However some patients may be suitable for same-day discharge. 

Care of your wound

Upon your hospital discharge, the ward staff will provide guidance on caring for your wound. If a dressing is applied, it is typically removable after a few days, unless instructed otherwise

In the initial days after surgery, your wound may exhibit a slight elevation and appear pink or red. This will gradually subside as the wound heals. Over time, the wound is expected to flatten and take on a paler appearance, although this process may extend over several months.

Unless recommended, it is not advisable to apply any ointments or bio-oils to the wound immediately after surgery, before it has had a chance to heal. It is recommended to wait until your post-operative clinic visit before considering the use of such products.

What can I expect after the operation, and how soon will I recover?

Experiencing fatigue after parathyroid surgery is normal, and any pre-existing tiredness symptoms may take a few weeks to fully subside.

In certain instances post-surgery, there might be a temporary drop in blood calcium levels as the body readjusts its calcium balance. Patients usually experience tingling or spasms in your lips, fingers, or toes after the procedure, it could signal a potential decrease in calcium levels. To avoid these symptoms, patients are given calcium supplements in the early post-operative period. 

After a neck exploration, you should regain normal eating and drinking capabilities, although some patients may initially feel a lump in their throat while swallowing. This sensation is common and typically fades over time.

Before returning to driving, ensure you can make an emergency stop without discomfort to your neck and comfortably turn your neck to look around while driving. It's advisable to inform your car insurance company about your parathyroid operation, as different insurers may have varying guidelines on the duration you should wait after the operation before resuming driving.

The timeline for returning to work depends on the nature of your job and the type of operation you underwent. Office-based work may be resumed after two to three weeks, while heavier work might require a four-week recovery period. Your surgical team will provide specific guidance tailored to your situation.

What are the possible complications of parathyroid surgery?

‍Complications of parathyroid surgery are uncommon. The vast majority of patients have straightforward surgery and are discharged the following day without any complications. Your surgeon will discuss the benefits and potential complications of surgery with you in detail. Please feel free to ask any questions that are on your mind.

Further information can be found on the BAETS website (www.BAETS.org.uk.)

For further information and support please visit Hypopara UK at www.hypopara.org.uk or call 01342 316315/01623 750330

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