Parathyroid Surgery

Abnormal parathyroid function occurs when the parathyroid gland inappropriately produces extra PTH even when your calcium level is high.
This causes the calcium level in your blood to rise even higher. Because PTH acts on the kidneys, the bones and the intestines there are a variety of symptoms that may be related to hyperparathyroidism. Hyperparathyroidism can cause kidney stones, decreased kidney function, thinning bones (osteopenia or osteoporosis) muscle and bone pain, abdominal pains and cramping. It can also contribute to other symptoms like acid reflux (GERD), concentration and memory difficulties, brain fog, high blood pressure, heart disease and abnormal heart rhythms.

Most often, there is one abnormal parathyroid gland (parathyroid adenoma) and the disease is cured when this abnormal gland is removed. Sometimes, two or three glands are abnormal (multi-gland disease), the disease is cured by removing these abnormal parathyroid glands. If all four parathyroid glands are abnormal (four-gland hyperplasia), three and a half glands are removed leaving a parathyroid remnant that is about the size of one normal gland. To have normal calcium and normal parathyroid function, you need at least one normal parathyroid gland or a remnant of a parathyroid gland of normal size.

After a parathyroid adenoma is removed, the other parathyroid glands are often sluggish and need time to wake back up and produce adequate PTH. If all four of your parathyroid glands were explored during surgery, the parathyroid glands need time to recover as they are often stunned and sometimes they are injured. The bones will also take up extra calcium after parathyroid surgery and you may have hungry bone syndrome causing low calcium levels in the blood. During this recovery process, you will need to take calcium supplements to support your body and ensure you have enough calcium in your bloodstream.

The recurrent laryngeal nerves are located behind the thyroid gland and close to the parathyroid glands. The recurrent laryngeal nerves travel to the larynx (voice box) and control the vocal cords and your voice. Stretching or bruising these nerves during surgery can cause hoarseness.

After parathyroid surgery, you will likely be able to go home the same day of your surgery. You will need to buy calcium supplements prior to surgery and expect to take this extra calcium until your post op visit. Recovery usually takes 1-2 weeks. Most of the postoperative soreness and discomfort will be relieved with chloraseptic throat lozenges (Cepacol) or spray to numb the throat, acetaminophen (Tylenol) and ibuprofen to reduce inflammation, and the use of an ice pack to reduce pain and swelling. Please plan to purchase these products and over the counter medications before your surgery. You may be offered a short course of narcotic pain medication, though most people do not require pain pills. After surgery you can eat a regular diet. Your incision will be covered with surgical glue, and you can shower when you return home. You should not drive for a few days after surgery until your neck soreness has resolved.

Read our parathyroid surgery post-procedure guide.

Abnormal parathyroid function occurs in patients with chronic kidney disease and in patients with end-stage kidney disease on dialysis.

Initially, elevated PTH levels are a normal response to maintain normal calcium and phosphorus levels. Chronic kidney disease reduces the production of activated vitamin D and increases phosphorus levels in the blood, creating a cycle that increases PTH levels and results in enlargement of the parathyroid glands. Medications are used to improve vitamin D, calcium, and phosphorus levels. After patients are on dialysis for a long time, PTH levels may become very high and medication may no longer work to control the calcium and phosphorus levels.

Secondary renal hyperparathyroidism is seen in patients on long-term dialysis and tertiary renal hyperparathyroidism is seen in patients after kidney transplant.

Surgery to treat secondary and tertiary renal hyperparathyroidism is considered for patients when medication is no longer effective and there is very high calcium, high phosphorus, calcifications under the skin, bone fractures, muscle weakness or bone/joint pains affecting quality of life. Parathyroid surgery may improve cardiovascular health in patients with renal hyperparathyroidism, improve bone density, and protect the transplanted kidney.

Most often, all four parathyroid glands are enlarged and abnormal (four-gland hyperplasia). Parathyroid surgery involves removal of three and a half glands (subtotal parathyroidectomy) or removal of all four parathyroid and implanting of a portion of a parathyroid gland back into the muscle of your neck or forearm (total parathyroidectomy with autotransplantation).

The recurrent laryngeal nerves are located behind the thyroid gland and close to the parathyroid glands. The recurrent laryngeal nerves travel to the larynx (voice box) and control the vocal cords and your voice. Stretching or bruising these nerves during surgery can cause hoarseness or voice changes.

After parathyroid surgery, you will likely need to stay in the hospital for several days after your surgery, and you may require a longer hospital stay to monitor and stabilize your calcium levels. You are at risk for very low calcium from hungry bone syndrome, your calcium levels will be checked several times per day, and you will need to take calcium supplements and activated vitamin D (calcitriol). If you are on dialysis, you will need inpatient dialysis with high calcium baths. Your nephrologist will coordinate your supplements and dialysis after you are discharged from the hospital.

Recovery usually takes 1-2 weeks. Most of the postoperative soreness and discomfort will be relieved with chloraseptic throat lozenges (Cepacol) or spray to numb the throat, acetaminophen (Tylenol) and/or ibuprofen to reduce inflammation, and the use of an ice pack to reduce pain and swelling. Please plan to purchase these products before your surgery. You may be offered a short course of narcotic pain medication, though most people do not require pain pills. After surgery you can eat your usual diet. Your incision will be covered with surgical glue and you can shower when you return home. You should not drive for a few days after surgery until your neck soreness has resolved.

Read our tertiary parathyroid surgery post-procedure guide.