Parathyroid Surgery

The parathyroid glands are four tiny structures, normally about the size of a grain of rice, closely positioned to the back of the thyroid gland. The parathyroid glands make a hormone (parathyroid hormone) that controls calcium levels in the blood. There are usually two parathyroid glands on each side of the neck.

When an enlarged parathyroid gland (or adenoma) produces too much parathyroid hormone, the condition is known as hyperparathyroidism. Excessive parathyroid hormone in the blood may cause an increase in blood calcium levels, a situation in which some patients do not have symptoms, however if left untreated could have a negative effect on the heart, bones, bowels, muscles, kidneys and brain, amongst other body systems.

Prior to surgery, you would have had a consultation with an endocrinologist to confirm the diagnosis of primary hyperparathyroidism, and had suitable imaging tests (such as ultrasound, sestamibi, and or CT scans) to localise the enlarged parathyroid adenoma.

You will also have the opportunity to meet your surgeon prior to the operation, during an outpatient consultation, at which the indications, risks, procedure, and post-operative considerations will be discussed in detail.

The Procedure

Parathyroid surgery is usually performed under a general anaesthetic and takes about an hour depending on complexity. Most patients will require only a small (2 to 3cm) central incision in the lower part of the neck for access. The parathyroid gland is carefully dissected from surrounding structures such as the thyroid gland and recurrent laryngeal nerve.

The recurrent laryngeal nerve controls movement of the vocal cords, whose function is important for speaking, swallowing, and breathing. The rate of permanent recurrent laryngeal nerve injury is very low (less than 1%), but if it does occur you may experience short or long-term voice change, and less commonly, swallowing or breathing problems. Parathyroid surgery at the New Victoria Hospital is performed using the latest nerve monitoring equipment that aids identification and preservation of the recurrent laryngeal nerve, with the aim of reducing the risk of nerve damage.

Due to the potential impact of thyroid surgery on vocal cord function, it is recommended that your surgeon confirms mobility of the vocal cords prior to the operation, by examining the larynx with a small flexible endoscope. This quick and painless procedure is usually performed at the time of your initial surgical outpatient consultation.

The neck incision is usually closed with absorbable stitches that do not require removal. A neck drain is not routinely used.

Following Surgery

Most patients require only a single overnight stay in hospital after their parathyroid operation. You are closely monitored on the ward by our nursing staff and allowed to eat and drink as soon as you have recovered sufficiently from the general anaesthetic. Early mobilisation is also encouraged.

Blood tests to check calcium and parathyroid hormone levels are performed within the first 6 to 12 hours of surgery. This allows the surgeon to confirm successful removal of the parathyroid adenoma, and in some cases helps guide the need for oral calcium supplements if blood calcium levels drop lower than normal in the short term.

Following discharge home with appropriate analgesia, you will require one to two weeks off work.

Outpatient follow-up usually takes place 11 to 14 days after surgery, at which the result from pathological analysis of the parathyroid is discussed, vocal cord function is confirmed following examination of the larynx with a small flexible endoscope, and the neck wound is also checked for appropriate healing.