Parathyroidectomy and Recovery | Saint John’s Cancer Institute

Parathyroidectomy is a minimally invasive surgery to remove the parathyroid glands or one or more parathyroid tumors from your neck.

All patients have minimally invasive parathyroid surgery (ie, a very small incision) to remove the abnormal parathyroid glands. It is as a same day, outpatient procedure. Surgery is performed under general anesthesia and all patients have Intraoperative PTH testing. There is no age that is “too old” for parathyroid surgery – it can have benefit in people of all ages when done for the appropriate reasons.

All patients will have a pre-operative parathyroid imaging to try and localize the parathyroid tumor before surgery.

State of the art surgical technique

Your parathyroid hormone level will be tested 4 times while you are asleep during surgery to make sure the correct parathyroid gland(s) have been removed before you are awoken from anesthesia. This is known as “intraoperative PTH testing”. It is the most sensitive and accurate intraoperative method for determining if your parathyroid disease has been ‘cured’ at the time of surgery.

Your PTH level is expected to be normal at the end of the operation.

Types of Parathyroid Surgery

Focused Parathyroidectomy

This targeted approach is possible when we have identified a probable parathyroid tumor on preoperative imaging. Only the abnormal parathyroid tumor is removed and very little other dissection is needed. Intraoperative PTH testing is used to confirm that the correct gland has been removed and that you only had one parathyroid tumor.

Four-gland Parathyroid Exploration

When all preoperative imaging is negative or inconclusive, all four of your parathyroid glands will be examined at the time of parathyroid surgery. The surgeon will then decide if one or more than one parathyroid gland needs to be removed. Intraoperative PTH testing is used to confirm that the correct gland(s) have been removed.

All of your parathyroid glands will also be examined if your PTH levels do not fall appropriately after a single gland is removed during a focused parathyroidectomy.

Re-operative parathyroid surgery

Occasionally, you may need a second parathyroid surgery because of recurrence (4-5% at 10 years) or because your first surgery did not result in a cure. It is important that this surgery is performed by a specialist because there is a lot of scar tissue and there is a small increased risk of complications (less so in experienced hands). Ideally, the parathyroid tumor should be localized on imaging before having this type of surgery.

How long does surgery take?

How long will I be hospitalized?

Will surgery affect my voice or cause any other side-effects?

Do you use any special techniques to ensure a successful parathyroid surgery?

Recovery

Everyone can eat, drink, and talk that same day right after surgery
While you may feel some fatigue for 2-3 days (general anesthesia), you will be able to perform your normal activities.
Most people only take a few days off from work.
You will have your serum calcium level checked the day after surgery to again confirm that the parathyroidectomy was successful.

Cosmetic result

Most patients heal very well from surgery and have minimal residual parathyroid surgery scar at 6 months.
The size of the incision will depend somewhat on if we are able to localize the hyperfunctioning parathyroid gland before surgery. However, all parathyroid surgeries are “minimally invasive parathyroidectomies” and almost all incisions are between 1.5-3.5 cm in length. Additionally, if you have a neck crease, we try to hide the parathyroidectomy scar in that line. All sutures are dissolvable.

What to Expect After Parathyroid Surgery

This information helps you understand your hospital stay so you have realistic expectations for the first few days after surgery. Following the guidelines will help you recover from your surgery as quickly as possible and reduce the risk of some complications.

What to expect on a day to day basis:

Day 0: The afternoon and evening of surgery:

Once you wake up you should start your breathing and leg exercises.
You will be encouraged to sit in a chair and walk in the hallway.
You will be allowed to have a full diet once you are fully awake from the anesthesia and without nausea.
You will be allowed to talk and move your neck as usual.
You will be started on oral pain pills including liquid Tylenol or liquid Tylenol/narcotic combination. No NSAIDs will be given. Chloraseptic spray and throat lozenges will be provided for your sore throat.
An Ice pack will be placed on your wound which you can take home.
Most of you will be allowed to go home the same day, depending on the extent of your operation and your other medical problems.

Day 1: The first post-op day:

You may shower once you get home.
You may resume your normal activities as you feel able.
You will be expected to go to a lab to get your blood calcium level checked

Specific points:

Breathing exercises:

These are extremely important. You should do these every hour during waking hours, taking at least ten deep breaths. This expands the small air sacs in the lungs and minimizes postoperative fever and pneumonia. You should continue these exercises for a few days once you return to your home. If you had outpatient surgery: you will need to get your calcium level checked on the first or second day after your surgery. If able to come to Providence Saint Johns, arrangements will be made when you leave the hospital. If a local facility is more convenient, a prescription will be given to you when you are discharged.

Going home:

When you go home, expect to be able to drink and eat freely. Your main complaint will be a sore throat that will last for 3-4 days; throat lozenge, chloraseptic spray, and ice cream/frozen yogurt (yes, your doctor is prescribing ice cream) provide the best relief. You may experience some swelling around the incision – this is normal.

Cold compresses sometimes provide relief. If you live alone, you may wish to make arrangements with family or friends in advance to stay with them for a day. If you live a long distance away from Providence Saint Johns, you may wish to make arrangements with a local hotel to stay nearby for a day before going home if you have outpatient surgery.

Upon discharge please call our office to make a follow-up appointment in 2-3 weeks.

Should any questions or concerns arise, please call our office: 310-829-8751
Monday – Friday: 8am -5pm Weekends, Holidays or after-hours

If you are not able to reach a live person, please call the hospital operator and ask for Dr. Goldfarb or Surgical Oncology fellow on-call.

Parathyroid Surgeon

Please submit an online appointment request or call 310-829-8751 if you have any questions, need a diagnosis, treatment or second opinion.

Dr. Melanie Goldfarb - Radiofrequency Ablation RFA - Saint Johns Cancer Institute

Melanie Goldfarb, MD, MSc, FACS, FACE

Professor of Surgery

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