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Parathyroidectomy
If you have been referred to us by your primary care physician, the following may be a review for you. We start with a discussion of an elevated level of calcium in the blood, which is called hypercalcemia.
What causes hypercalcemia? There are several possible causes:
- Too much calcium in nutrition
- Medical conditions like sarcoidosis
- An overactive parathyroid gland
- Cancer
What does it feel like to have hypercalcemia? There are no signs or symptoms outwardly. It is silent like high blood pressure. However, if it is left untreated it can lead to:
- Osteoporosis
- Kidney Stones
- General Malaise and fatigue
- Pancreatitis
- Peptic (stomach) Ulcers
- Frequent Urinination
How do I know if I have too much calcium in my blood? Your primary care physician can order a blood test.
What treatments are available? Your primary care physician will most likely refer you to an endocrinologist, a doctor that specializes in hormonal (gland) disorders. The treatment of choice depends on the cause. If the cause is an overactive parathyroid gland it will need to be removed, and thus you are referred to Dr. Coniglio.
What is a parathyroid gland? We have four tiny parathyroid glands located within the thyroid that secrete a hormone to regulate calcium. This hormone, which can be measured in the blood, is called parathormone (PTH). If the PTH level is elevated, one has hyperparathyroidism.
Tell me about the surgery. The surgery is called a parathyroidectomy (excision of a parathyroid gland). The procedure is done under general anesthesia and takes about an hour. Patients stay one night in the hospital to be sure that swallowing, breathing and talking are all ok. The incision falls in a natural skin crease in your neck that is barely visible after it heals.
For more information about parathyroid surgery, please see our patient teaching instruction sheet on parathyroidectomy. Please call on any of us at anytime to assist you with this information. We are all here to help in any way we can.
When you call the hospital on the business day before the procedure you will be given an arrival time that will be about an hour prior to the procedure. Upon arrival at the hospital you will talk with a nurse (who will also start an IV), an anesthesiologist and Dr. Coniglio before the procedure. Dr. Coniglio will take care to place the incision along a natural skin crease to minimize any scarring.
Pre-Operative Instructions
- Nothing to eat or drink after midnight the evening before the procedure. This includes all food, liquids, water, candy, mints or gum. You may brush your teeth. Your procedure will be cancelled if you do not follow these instructions.
- Please notify us of any medications and the dosage including insulin or allergies you may have. If you take routine medications, please take them as directed with just a sip of water in the a.m.
- Please avoid any aspirin, aspirin-containing products or ibuprofen (Advil®, Vitamin E, Aleve®, etc.) for one week prior to your surgery. If you are on any medications that affect bleeding (such as coumadin or warfarin) please notify the office immediately.
- Please remove all make-up, nail polish and false nails before surgery. This will help your surgical team evaluate the blood oxygen during your procedure.
- Do not bring valuables (cash, credit cards, watches, jewelry, etc.) to the Center. Upon your arrival you will be given a bag for your belongings. These will be given to your family to take to the unit where you will be admitted postoperatively.
- Remove all make-up and nail polish before coming to the procedure center.
- Please call the hospital, the business day prior to your procedure to confirm your arrival time.
Following surgery you will have a soft drain in the surgical incision. The drain will be removed in the morning prior to your discharge. Removal of this drain has been described by most patients as discomfort rather than pain. You will most likely experience some neck stiffness and discomfort that should be well managed by your pain medications. If there is excessive swelling, steroids will be prescribed to minimize the swelling. You will go home with steristrips along the incision line, which must be kept dry to remain in place.
After surgery it is not uncommon to have sensation of fullness or numbness of the side of the face, neck and lower ear on the affected side. Therefore, hairdryers, curling irons and extremely hot bath water should be avoided or used with the utmost care in the immediate postoperative period. Prior to your hospital discharge, the nurses will assist you to meet the discharge criteria: to drink liquids, walk with a steady gait, manage your discomfort, and to have any drainage under control. You will be asked to come to Dr. Coniglio's office for a two-week postoperative appointment.
Post-Operative Instructions
- Advance diet from liquids to soft food to solids as tolerated. Avoid hot liquids or food.
- You will have a drain that will be removed as soon as the drainage is minimal.
- If indicated at the time of your discharge from the hospital, you will be given a prescription for pain medication. Use the pain medication for the first few days. After that acetaminophen or ibuprofen may be used according to package directions.
- You will be given an antibiotic prescription at the time of hospital discharge. It is important that you complete the antibiotic as prescribed.
- No heavy lifting, bending or straining for two weeks following surgery.
- You will have steristrips over your incision. It is important to keep these dry. You may shower and wash your hair if you cover the steristrips. With clear plastic wrap make a window over the steristrips and tape around the edges of the plastic wrap.
- Patients who have parathyroid surgery may be required to take calcium supplements to restore blood calcium after surgery. Soon after your surgery you will be asked to follow up with your primary care physician regarding medication, including repeat laboratory tests of hormone and calcium blood levels.
- Notify the office for any of the following:
- difficulty breathing or painful swallowing
- coughing up blood or persistent bleeding: (You may notice some slight blood-tinged sputum which is not uncommon.)
- significant swelling of the neck or back of throat
- pain unrelieved by your prescribed pain medication
- for any emergency you may call our professional answering service at 258-4840.
Your first follow-up appointment in Dr. Coniglio's office will be scheduled for two weeks postoperatively. Immediately following that appointment you will be asked to go to the lab (to check your hormone and calcium levels). If you did not make an appointment before your surgery for this visit, please call the office at 256-3550 to schedule one.
Depending on the final diagnosis of the gland removed, follow-up by your primary care physician, endocrinologist and/or surgeon may be indicated. Please call the office after ten days if you have not heard the pathology results or to make a follow-up plan.
Dr. John U. Coniglio and Staff
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