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  • Parathyroidectomy—Conventional

    (Parathyroidectomy—Open; Parathyroidectomy—Standard; Parathyroid Gland Removal—Conventional; Parathyroid Gland Removal—Open; Parathyroid Gland Removal—Standard)

    Definition

    A parathyroidectomy is a surgery to remove abnormal parathyroid glands. There are four parathyroid glands located in the neck. The glands make parathyroid hormone, which is used to control calcium levels in the blood.
    Parathyroid Glands and Thyroid Glands (Back View)
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    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    The surgery is done to remove one or more abnormal parathyroid glands. The glands can be abnormal due to cancer or for other reasons.

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are planning to have a parathyroidectomy, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Hoarseness
    • Low calcium levels in the blood
    • Wound infection
    • Reaction to the anesthesia
    • Skin tethering—tissues and skin may become attached to the voice box or windpipe
    • Scarring
    • Blocked airway
    • Damage to nerves (which can cause problems like paralyzed vocal cords)
    Factors that may increase the risk of complications include:
    Talk to your doctor about these risks before the surgery.

    What to Expect

    Prior to Procedure

    Your doctor will:
    • Do a physical exam and ask you about your medical history
    • Order imaging scans (eg, ultrasound)
    • Have blood tests done
    You should:
    • Arrange to have someone drive you home from the hospital after surgery.
    • Avoid eating or drinking 6-8 hours before surgery.
    • Talk to your doctor about your medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen , naproxen )
      • Blood-thinning drugs, such as warfarin (Coumadin)
      • Anti-platelet drugs, such as clopidogrel (Plavix)

    Anesthesia

    General anesthesia will be used. It will block any pain. You will stay asleep through the surgery. In some cases, local anesthesia may also be used.

    Description of the Procedure

    The surgeon will make a 2 to 2-½ inch (5-6 centimeter) cut in the neck. He will need to move away neck muscles and the thyroid to locate all the glands. Once the abnormal gland is located, he will cut it out and remove it. A drain may then be placed in the area where the surgery was done. The cut will be closed with stitches.

    How Long Will It Take?

    20 minutes to several hours (depending on how many glands need to be removed)

    How Much Will It Hurt?

    Anesthesia prevents pain during surgery. After the surgery, you may feel like you have a cold or sore throat . Your doctor will give you pain medicine.

    Average Hospital Stay

    This procedure is done in a hospital setting. The usual length of stay is 1-2 days. Your doctor may choose to keep you longer if you have any problems.

    Post-procedure Care

    At the Hospital
    The hospital staff will:
    • Observe you in the recovery room
    • Check on your ability to swallow and speak
    • Show you how to change your dressings and care for your wound
    • Remove the drain if one was placed during surgery
    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • You may be given calcium supplements.
    • Check your wound daily for signs of infection.
    • You may want to eat semi-solid foods, like ice cream or oatmeal, for the first few days. These types of foods will be easier to swallow.
    • Be sure to follow your doctor’s instructions.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Tingling or numbness in the fingertips, toes, hands, or around the mouth
    • Twitching or cramping of muscles
    • Redness, warmth, drainage, or swelling around the area where surgery was done
    • Difficulty swallowing, talking, or breathing
    • Signs of infection, including fever and chills
    In case of an emergency, call for medical help right away.

    RESOURCES

    The American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS) http://www.entnet.org/

    The American Association of Endocrine Surgeons http://www.endocrinesurgery.org/

    National Cancer Institute http://www.cancer.gov/

    CANADIAN RESOURCES

    Canadian Cancer Society http://www.cancer.ca/

    Canadian Society of Otolaryngology http://www.entcanada.org/

    References

    Farndon JR. Postoperative complications of parathyroidectomy. In: Holzheimer RG, Mannick JA. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich, Germany: Zuckschwerdt; 2001. National Center for Biotechnology Information website. Available at: http://www.ncbi.nlm.nih.gov/books/NBK6967/ . Accessed February 19, 2011.

    Parathyroid surgery. The American Association of Endocrine Surgeons website. Available at: http://www.endocrinesurgery.org/patient%5Feducation/parathyroid/surgery%5Foverview.shtml . Accessed February 19, 2011.

    Parathyroidectomy. Baylor College of Medicine website. Available at: http://www.debakeydepartmentofsurgery.org/home/content.cfm?proc%5Fname=Parathyroidectomy&content%5Fid=274 . Updated February 18, 2011. Accessed February 19, 2011.

    Parathyroidectomy. Cedars-Sinai website. Available at: http://acromegalysupport.org/Patients/Programs-and-Services/Head-and-Neck-Cancer-Center/Treatment/Parathyroidectomy.aspx . Accessed February 19, 2011.

    6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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