The Redmond Clinic

Hyperparathyroidism

What are the parathyroid glands?

There are four parathyroid glands in your neck, each the size of a grain of rice. They are usually situated next to the thyroid gland. They regulate the calcium level in your blood. Sometimes one or more of these glands does not work properly and your calcium level rises above normal.

Abnormal Conditions of the parathyroid

If one or more of your parathyroid glands are overactive it leads to a raised calcium level in
your blood. Because of this you might experience the following symptoms:
• You might feel more tired and sleepy
• Your muscles may feel weak or tender
• Your joints can become sore
• You may need to pass urine more often
• You are more likely to form kidney stones • Some people develop constipation
• You may feel nervous or have a low mood • You may have memory loss

How can it be treated?

The only curative treatment for this condition is to have an operation to remove one or more of the diseased glands. After careful consideration of your symptoms and physical and laboratory tests, your doctor has recommended that you have a parathyroid operation. While you are waiting for the operation you should keep well hydrated (try to drink an extra 1 litre/2 pints of fluids daily). This helps to prevent a build-up of calcium deposits in the body.

If the scans have found the position of the overactive parathyroid gland, you could have a minimally invasive radio guided parathyroidectomy (MIRP). This is when the gland is removed through a small cut (less than 1 inch/3cm) made on your neck. In about one in three patients the scans are not able to find the enlarged gland. If this happens, you will need a routine parathyroidectomy. This uses a slightly longer cut (about 2 inches/5cm) in the front of your neck, through which all four glands can be seen and the enlarged one removed.

What does the operation involve?
The operation is generally carried out under general anaesthetic (you are asleep). In some cases it might be possible to be done under local anaesthetic (where the area is numbed).At the beginning of the operation a blue dye may be injected into a vein in your arm. This dye collects in the parathyroid glands and makes them easier to find during the operation the dye is removed later from your body by your kidneys. Your urine will be green for a couple of days after the operation.

Minimally Invasive Radio-Guided Parathyroidectomy (MIRP)
On the day of surgery, you will have a sestamibi scan in the nuclear medicine (X-ray) department to localize your enlarged parathyroid gland. You will then have a small (2-3cm) incision over your neck crease to remove that enlarged parathyroid gland / adenoma.

Routine parathyroidectomy
If the pre-operative scans did not find the position of your overactive parathyroid gland, the surgeon will make a 2 inch cut in a skin crease in the middle of your neck. The surgeon will use this larger cut to explore both sides of your neck to find and remove the enlarged parathyroid gland.

Will it hurt?
For the first few days after your operation you should expect some discomfort in your neck and when swallowing. You will be given painkillers to take home and you may want to take these regularly at first.

Risks

• Failure to find the enlarged/overactive parathyroid gland. Even if the pre-operative scans found the position of the overactive parathyroid gland, there is still a very
small possibility that the surgeon will not find the parathyroid gland during the operation. Because of this it might be necessary to make a longer cut and to look for
the enlarged /overactive parathyroid gland on both sides of the neck. Even then although this is rare) the surgeon may not be able to find the offending parathyroid
gland. In our experience this happens in 2-3 patients in 100. •

– Injury to the recurrent laryngeal nerve (risk approximately 1 in 200). This nerve asses close to the thyroid and parathyroid glands and controls movement of the vocal cord on that side of the neck. Injury to this nerve causes hoarseness and weakness of the voice. This problem is more common after thyroid surgery. Generally this problem lasts for several months before the voice returns to normal.

• Voice changes. Any operation on the neck can produce some change in the voice; fortunately this is not normally easy to hear and it settles within a few months. You
might find your voice is slightly deeper and you might experience voice fatigue (tiredness). This can be difficult for people who use their voice for professional
reasons. Please ask for further details if you have any particular concerns.

• Bleeding. (less than 1%) This is a rare complication which can lead to neck discomfort. Very rarely patients will need to return to theatre to have their neck explored so that the cause of bleeding can be identified and dealt with.

• Low blood calcium levels. Once the overactive parathyroid gland has been removed, the other glands may take a few days before returning to normal activity. In
addition, your bones may absorb more calcium from your blood (a condition called “hungry bone syndrome”). For these reasons your calcium levels can drop too much
after the operation. This could cause tingling in your lips and fingers. To prevent such problems, we may prescribe calcium tables for you to take for the first two weeks
after the operation.

• Scar. Your scar may become thick and red for a few months after the operation before fading to a thin white line. Very rarely patients develop a thick, raised scar.

• Infection (less than 1%)

These potential side effects and complications are extremely rare. 

What Are The Risks of General Anesthetic

Modern anaesthesia is very safe and serious problems are uncommon. After an anaesthetic it is common to feel sick or vomit or experience the following:
sore throat, dizziness, blurred vision, headache, itching, aches, pains and backache.

About 1 in 10 people experience these side effects.
 It is uncommon (1 in 1000 people) to have a chest infection, bladder problems, muscle pains, slow breathing (depressed respiration), damage to teeth, lips or
tongue, an existing medical condition getting worse. Rarely (1 in 10,000 people or less) patients have damage to their eyes, a serious drug
allergy, nerve damage, equipment failure, awareness (becoming conscious during your operation) or death. The risk to you as an individual will depend on whether you have any other illness, personal factors (such as smoking or being overweight), or surgery which is complicated, long or done
in an emergency. 

Pre-operative Assessment
Most patients come for an appointment at the Pre-operative Assessment Clinic. At this clinic you will be asked for details of your medical history and any necessary clinical examinations and investigations will be carried out. This is a good opportunity for you to ask any questions about the operation. You will be asked about any medicines or tablets that you are taking – either prescribed by a doctor or bought over the counter in a pharmacy. It helps if you bring details of your
medicines with you – for example, bring the packaging or a repeat prescription with you.

Going Home Going home
You will normally be allowed home the day after your operation. If you have an MIRP you may be allowed to go home on the day of surgery. When you get home you should rest for 2-3 days.

Wound care
The wound should be kept dry for 48 hours. The steri-strips should stay on for up to one week. Stitches are dissolvable so there is no need to go to your GP for removal.
A detailed wound care sheet will be provided after the surgery at the time of your discharge.

Is there anything I should look out for when I go home?
If you have any concerns about your wound because it is red, hot, swollen or painful you should seek advice from your GP or practice nurse.

Follow up
We will give you an appointment to be seen in the Outpatient Department (Bandon Suite) or in the Private rooms about 6 weeks after your operation. At this time your consultant or his/her team will discuss the (pathology) results with you as well as any further treatment and follow up you may need