Parathyroid surgery

The thyroid and the parathyroids are glands that secrete hormones. The thyroid is located at the base of the neck, in front of the trachea and below the larynx. It is made up of two lobes joined by an isthmus (giving it a butterfly shape). There are 4 parathyroid glands, two located behind each thyroid lobe.

Thyroid conditions are generally easy to treat. Treatments are medical and surgical, and lifelong medical hormone treatment is sometimes necessary. Thyroid surgery and parathyroid surgery are now considered simple, standardised operations.

Indications for parathyroid surgery:

Parathyroid adenoma.
Parathyroid hyperplasia.
Parathyroid cancer (very rare).

What are the parathyroid glands?

The parathyroid glands are very small glands located in the neck, in close contact with the thyroid gland. There are usually 4 of them and, in their normal state, they look a little like a small lentil. Small as they are, they play a very important role.
In fact, they secrete a chemical substance that is released into the blood that flows through them and nourishes them. This substance is a hormone, parathyroid hormone, which acts in various ways on several organs, the main ones being the kidneys, the bones and the intestine.

3D view of the thyroid and parathyroid glands in the neck

When should I have surgery?

For reasons that are often poorly understood, one or more of the 4 parathyroid glands may enlarge abnormally and start releasing excessive amounts of parathyroid hormone into the bloodstream. This excess parathyroid hormone then has harmful effects on many organs: the bones lose their calcium and become fragile, sometimes to the point of breaking spontaneously,

the kidneys become loaded with calcium crystals that form gravel and stones, which damage them and give rise to “kidney stones”, the arteries calcify and lose their elasticity, and brain and muscle function is sometimes seriously disrupted. The only solution to such a problem is to remove the overactive parathyroid gland or glands.

How is the operation performed?

You are admitted to hospital the evening before or on the morning of the operation, as arranged with your surgeon.
The operation is performed under general anaesthesia. The patient lies on their back with the head slightly tilted back. During the surgical and anaesthetic consultations, it is important to mention anything specific about the condition of your neck, whether past medical history, previous surgery or any other particular anatomical feature.
The incision is horizontal and discreet, made in the natural creases of the neck so that the scar becomes almost invisible over time. At the end of the operation, a small suction drain is put in place for a few hours, and the skin is then carefully closed.

On average, the operation lasts between 40 minutes and 1 hour 30 minutes. Afterwards, you are transferred to the recovery room, where you will stay until you have fully regained your independence.

Immediately after surgery
Post-operative pain is managed jointly by the anaesthetist and the surgeon. This surgery is generally not very painful: the discomfort feels more like a severe sore throat than intense surgical pain.

Anatomy of the parathyroid glands at the back of the thyroid

Post-operative advice

Eating and going home
Eating resumes without restriction from the day after the operation. If a drain has been put in place, it is removed within 24 to 48 hours. Discharge from hospital usually takes place on day 2 after the operation, with no need for a stay in a convalescent home.

The scar
The skin is closed with staples: half of them are removed as early as the next day and the rest on the following day. In our experience, this technique gives the best cosmetic results. The scar is then left uncovered, without a dressing.
A few simple precautions help the scar to heal well:
Avoid getting the scar wet for 10 days, or dry it quickly if it comes into contact with water
Avoid sun exposure for several months; if exposed, apply a high-protection sunscreen
Once the wound has fully healed, local massage may improve the cosmetic result
It is common for a slight ridge to appear at first; this is completely normal. At around nine months, the scar is reduced to a fine, barely noticeable white line.

Functional recovery
Temporary discomfort when swallowing may be noticed in the early days. Pain remains moderate, comparable to that of a sore throat, and is relieved by the painkillers prescribed on discharge.

A drop in calcium: a sign of cure
After a thyroidectomy, it is common for the blood calcium level to fall temporarily. This may show up as tingling in the fingers, the toes or around the mouth, or even cramps in the hands. When these signs appear, they simply indicate that the operation has achieved its goal.
Treatment with calcium tablets, and sometimes vitamin D, will be prescribed for a period tailored to each patient, and adjusted according to clinical progress and laboratory results.

Post-operative follow-up
All your prescriptions will be given to you before you leave, together with a prescription for a blood test to be carried out three weeks after the operation, to check your calcium and thyroid hormone levels. A follow-up consultation with Dr Deroide is scheduled at one month.

Complications of parathyroidectomy

Every surgical procedure and every anaesthetic carries risks that it is impossible to list exhaustively. Apart from complications that the medical precautions taken have made extremely rare, here are the main risks to which a patient undergoing parathyroid surgery may be exposed.

Microscopic illustration of glandular cells

1. Post-operative haemorrhage
The most immediate risk is bleeding, which may occur in the minutes or hours following the operation. This complication does not pose a major danger provided it is detected and treated promptly. This is why close monitoring is provided in the recovery room, sometimes for several hours. If necessary, the patient is taken back to the operating room so that the surgeon can control the bleeding.

2. Voice problems
A change in the voice (altered tone, a husky or weakened voice) may occur if one or both of the recurrent nerves, which control the movements of the vocal cords, are injured. These very fine nerves run along the thyroid and receive constant attention throughout the operation. Despite all the surgeon’s precautions, damage to them remains possible in exceptional cases.
Fortunately, this complication is temporary in the vast majority of cases. Recovering a normal voice may nevertheless take several months, require speech therapy sessions and, in very rare situations, further surgery on the vocal cords or the trachea.

3. Failure to cure
In about 2% of cases, the parathyroid disease may persist if the affected gland could not be located during the operation, particularly when it is in an unusual position, in the chest or very high in the neck. Repeat surgery or additional treatment may then be considered.

4. Associated thyroid surgery
In some situations, a cure requires removing part of the thyroid, when the diseased parathyroid gland has become embedded in it. The surgeon will inform you if this possibility arises.

Frequently asked questions about parathyroid surgery

Will I have a scar?

All surgery leaves a scar. How well a scar heals depends greatly on the type of skin, which varies from one person to another. Nevertheless, the surgeon has several means of obtaining a good-looking scar: a small, well-placed incision and the use of hypoallergenic suture material. A thyroidectomy performed by an endocrine surgeon is the best assurance of a discreet scar in a cosmetically suitable position. Most patients are very satisfied with their scar after 6 months.

Why is the area of my neck around my scar swollen in the days following my operation?

This is a normal part of the healing process and corresponds to inflammation of the tissues under the skin. Bear in mind that the scar will reach its final appearance after 6 to 9 months. To speed up the cosmetic result, you can gently massage the scar with a moisturising cream from the 15th day after the operation.

Will there be any restrictions after my operation?

The first week is marked by neck pain that closely resembles a “severe sore throat”. You can shower as soon as you get home. Swimming and sport must be avoided for about 21 days.

Will I lose my voice after parathyroid surgery?

Your voice may indeed sometimes undergo a temporary change, such as voice fatigue or hoarseness. In most cases, everything returns to normal within 6 to 8 weeks. Fewer than 1% of patients have a permanent change in their voice. To reduce this risk as much as possible, it is important to be treated by a surgical team with expertise in this delicate surgery.

What are the signs of a sharp drop in blood calcium after surgery?

A few patients have a sharp drop in blood calcium after parathyroid surgery (this is known as hypocalcaemia). The most common symptoms are tingling in the extremities (particularly in the fingers and around the mouth), which can progress to tetany and temporary paralysis. If you experience such signs, you must tell your surgeon promptly.

Book an appointment with Dr Deroide today for a personalised diagnosis.

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