How much calcium should I take after surgery?
All of our patients are discharged on oral calcium supplementation to provide your calcium needs while your “normal” parathyroid glands wake up. The typical dose is Caltrate 600mg with D, twice per day (one tablet in the morning and one tablet in the evening). Some patients may be discharged on a higher dose. It is important that you obtain the calcium supplements prior to surgery so that you are not scrambling to find calcium after your surgery. Please start taking the calcium the day of surgery.
Will I be discharged same day as surgery?
About 95% of our patients are discharged the same day as their surgery, typically within 2 hours.
What type of anesthesia will I have?
Parathyroid surgery can be performed under two types of anesthesia: general or local anesthesia. With general anesthesia an endotracheal tube is carefully placed in your airway and you are completely asleep during the operation. With local anesthesia, you receive intravenous sedation and your neck area is numbed with a local anesthetic. With the local anesthesia approach, patients are kept in a “twilight” state during surgery and usually have no recall of the operation. Either approach is safe and allows for same day discharge. Most parathyroid operations are performed under local anesthesia.
How will my voice be monitored during surgery?
Voice monitoring can be performed by having patients speak during surgery while under local/regional anesthesia. In some circumstances, your surgeon may use intra-operative nerve monitoring during your surgery, but this approach requires a general anesthesia.
Will my surgeon use parathyroid hormone (PTH) monitoring during surgery?
PTH monitoring during surgery will allow your surgeon to know if you have been cured during the operation by demonstrating an appropriate decrease in your PTH level after removal of the abnormal gland.
Will I have pain after the operation?
All operations involve some pain and discomfort. Our goal is to minimize this discomfort. At the time of operation, your surgeon will give you some numbing medicine, which usually lasts about four to six hours after surgery. Although you should be able to eat and drink normally, the main complaint is pain with swallowing. Most patients take Tylenol® or Motrin® to keep them comfortable at home, but you will receive a prescription for a mild painkiller.
Will I have any physical restrictions?
Swimming is the only major restriction. In general, your activity level depends on how much discomfort you experience. Many patients have resumed regular activities within days after the operation. Most patients are able to return to work within the first week, and you are able to drive as soon as your head can be turned comfortably (this limitation is for driver safety).
When can I return to work?
Since we perform minimally invasive, outpatient parathyroid surgery, patients typically recovery very quickly from surgery. Patients can return to work two to three days after surgery.
Will I have stitches?
Your incision will be closed with a single suture under the skin and may be covered with a special kind of skin glue. The skin glue is waterproof so that you can shower as usual (but do not submerge the incision for 5 days). The coating will peel off on its own within seven to ten days and a moisturizer can be applied to the wound at that time.
Will I have a scar?
Yes, all surgery causes scarring, and how a patient scars is dependent on the individual. However, there are techniques that surgeons use to minimize scarring. These techniques include smaller incision size, careful incision placement, and hypoallergenic suture materials (to avoid inflammation). As a general rule, it is unusual for adults to have a noticeable scar after six months. Please apply sun block to your scar for the first year after surgery.
What are the complications unique to parathyroid surgery?
Parathyroid surgery is safe; however, complications are directly related to the experience of the operating surgeon (i.e. the more experienced your surgeon, the better the outcome). Although the risk of these complications cannot be eliminated entirely, they are minimized in the hands of an experienced parathyroid surgeons.
Voice changes – Injuries of the nerves that control the voice are very rare in parathyroid surgery (about one in 300) and most are associated with parathyroid cancers or concomitant thyroid surgery. When this occurs, the main difficulties are projection of the voice and high-pitched sounds. It is usually described as a “hoarse” voice, but will not necessarily be considered abnormal by strangers. Usually voice changes are temporary, so the voice will return to normal within a few weeks; permanent change is very rare.
Low calcium levels – Up to 40 percent of people will have a temporary low calcium level post-op, and this is usually caused by the fact that once the hyperactive parathyroid gland(s) is removed, the remaining parathyroids take time to “wake up.” Less than one percent (one in 200-300 people) may have a permanent low calcium levels. Symptoms of hypocalcemia include numbness and tingling in your hands, soles of your feet and around your lips. Some patients experience a “crawling” sensation in the skin, muscle cramps, or severe headaches. These symptoms appear between 24 and 48 hours after surgery. It is rare for them to appear after 72 hours. Symptoms can generally be prevented by taking calcium three times daily for seven days after surgery (Tums®, Caltrate® or Oscal® with Vitamin D). After the seventh day, reduce calcium to 1000-1200-mg daily. If symptoms develop, you should take extra calcium and notify your surgeon.
Bleeding in the neck – Bleeding is a rare (one in 300 patients) but potentially serious complication. You will be carefully observed for two to three hours in the recovery room (and sometimes stay overnight). Signs of a potential bleeding problem include: swelling in the neck, feeling short of breath, a choking sensation, and a high, squeaky voice.
What is the cure rate of parathyroid surgery?
In experienced hands, close to 98 percent of patients will be cured of their hyperparathyroidism.
When do I follow up?
Soon after your surgery, please call your surgeon’s office to make an appointment to be evaluated approximately one to three weeks after surgery. During your post-op visit, your surgeon will measure your calcium, PTH and Vitamin D levels. Copies of these lab result will be sent to you and to your referring provider.