Parathyroidectomy

University Surgeons Associates surgeons perform parathyroidectomy as the primary treatment for hyperparathyroidism.  This condition is an excess of parathyroid hormone causing an elevated calcium level in the bloodstream.  This is due to over activity of one or more of the parathyroid glands. These oval, grain-of-rice-sized parathyroid glands are located in your neck next to the thyroid gland.  Long term effects of hyperparathyroidism include severe osteoporosis and renal damage.

Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in 95 percent of all cases. Your University Surgeons Associates surgeon will remove those glands that are enlarged or have a tumor (adenoma).  A portion of one parathyroid gland may be left in the neck or auto transplanted in the arm to supply some parathyroid function.

minimally invasive radioguided parathyroidectomy (mirp)

New advances in medical technology have enabled the surgeons at University Surgeons Associates to perform parathyroid surgery on the majority of patients in a quick, exact and less complicated procedure called the Minimally Invasive Radioguided Parathyroidectomy (MIRP).  Patients whose glands are not seen on scans or have multiple gland disease are not candidates for a MIRP.  They require exploration and removal of multiple parathyroid glands.

advantages of the mirp procedure

Historically, a complete exploration was needed to address parathyroid problems.    The MIRP procedure is a safe and effective way to operate with cure rates equal to the more extensive and complicated operation that was performed.   Advantages of the MIRP Procedure include:

• Local anesthesia may be used in some cases
• Significantly smaller incision
• Fewer complications than the standard operation
• Smaller overall operation so less pain
• Patients often return to normal activities sooner

what to do before Surgery?

• Imaging of the parathyroids with a nuclear Sestamibi scan and/or a 4D CT scan to determine if a single gland is the problem and to show the position of the gland.
• Preoperative preparation includes blood work, medical evaluation, chest x-ray and an EKG depending on your age and medical condition.
• After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery.
• It is recommended that you shower with an antibacterial soap the night before or morning of the operation.
• After midnight the night before the operation, you should not eat or drink anything except medications that your surgeon and/or anesthesiologist has told you to take with a sip of water the morning of surgery.
• Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and large doses of Vitamin E will need to be stopped temporarily for several days to a week prior to surgery.
• Diet medication or St. John’s Wort should not be used for the two weeks prior to surgery.
• Quit smoking and arrange for any help you may need at home.  

how is a mirp performed?

You will most likely be asked to check into the hospital the morning of your surgery.

• A 10 minute Sestamibi scan is done prior to surgery.
• A MIRP is performed under a local or a general anesthesia.
• A small incision is made in the front of the neck over the identified abnormal parathyroid.
• A handheld gamma camera is used to guide the surgeon to the abnormal gland and it is removed.
• An intraoperative parathyroid hormone level is obtained to help confirm that there is only one abnormal gland.
• During the surgery, a nerve monitor is typically used to help identify and protect the vocal cord nerve. 
• After the surgeon removes the abnormal parathyroid gland, the small incision is closed.

what should i expect after surgery?

Our goal is for your surgery and recovery to be as comfortable and convenient as possible.  After a parathyroidectomy, you may experience temporary neck pain and a hoarse or weak voice. A  sore throat and some difficulty swallowing may last for 3-7 days.  Some patients benefit from calcium and vitamin D supplementation after parathyroid surgery.

• Most Patients are able to engage in light activity while at home after surgery. Patients can shower over their steristrips and tegaderm dressing the day after the operation.
• Post-operative pain is generally mild and patients may require a pain pill or pain medication.
• Most patients can resume normal activities sooner than one week, including driving, walking up stairs, light lifting, and work.
• You should call and schedule a follow-up appointment within 2 weeks after your operation.

what complications can occur?

Parathyroid surgery is generally considered extremely safe. As with any operation, there is a risk of a complication. Complications during the operation may include:

• Hoarse or weak voice which in rare cases may be permanent
• Hypoparathyroidism causing low levels of calcium in your blood (hypocalcemia)
• Bleeding and airway obstruction
• Rarely infection of the wound
• Adverse reaction to general anesthesia

when to call your doctor

Be sure to call your physician or surgeon if you develop any of the following symptoms after surgery:

• Numbness or tingling of toes, fingers or around the mouth
• Persistent fever over 101 degrees F (39 C)
• Chills
• Bleeding
• Pain that is not relieved by your medications
• Persistent nausea or vomiting
• You are unable to eat or drink liquids
• Persistent cough or shortness of breath
• Purulent drainage (pus) from the incision
• Redness surrounding the incision that is worsening or getting bigger