General
Considerations
Parathyroidectomy is performed under
general anesthesia. Patients are
given a dose of prophylactic
antibiotics prior to the procedure.
The patient is positioned in such a
way that the neck is extended
slightly.
After
the patient is draped in sterile
towels and drapes, an incision is
planned, usually about two
fingerbreadths above the bony notch
at the base of the neck. This
incision is carried down through the
soft tissues of the neck until the
strap muscles that cover the thyroid
are found. These strap muscles are
separated and spread apart to expose
the thyroid gland.
The
side of the neck that is suspected (as
based on imaging studies) to
contain the parathyroid adenoma is
then explored. The inferior lobe of
the thyroid gland is mobilized. The
recurrent laryngeal nerve and
inferior parathyroid gland are
identified and preserved. The
superior lobe of the thyroid is
mobilized to identify the superior
parathyroid gland. The diseased
parathyroid gland is then removed.
If an adenoma is not identified,
then the other side of the neck can
be explored.
Our
practice has used rapid measurement
of parathyroid hormone level with
frozen section of the gland to
determine that the adenomatous gland
has been removed.
After
the disease gland has been removed,
a surgical drain is placed to
prevent accumulation of blood or
fluid in the surgical bed. The
wound is then closed in layers with
sutures.
Expected
post-operative course
Patients are admitted for
observation post-operatively.
Calcium levels are usually checked,
especially if more than one gland
has been biopsied. Once the wound
drain output is below an appropriate
level, the drain is removed and the
patient is sent home.
Patients are seen in the office
about one week following surgery.
Stitches, if present, are removed.
An additional determination of
parathyroid hormone level and
calcium might be ordered.
Instructions
for Patients following
Parathyroidectomy
Wound care. If your wound is
covered by surgical tapes, leave
these tapes alone until directed by
your physician to remove them. If
your wound has exposed stitches,
then follow these instructions:
Wash your hands. Clean the wound
with hydrogen peroxide and apply
antibiotic ointment twice daily.
Polysporin and Neosporin ointments,
which are available over the
counter, are appropriate to use.
Medications.
Take your medications as prescribed
by your physician. Acetaminophen (Tylenol
or Extra-Strength Tylenol) might
be sufficient for pain relief.
Avoid any medications that contain
aspirin or ibuprofen.
Do not drive or make important
decisions while taking narcotic pain
medications. If you need refills
for medications, please call during
regular office hours.
Diet. Eat a well-balanced,
healthy diet. There are no
particular restrictions.
Activity level. Avoid any
strenuous activity for at least two
weeks after your surgery. This
means you should limit lifting
anything more than about ten pounds
following your surgery.
Showering and bathing. It is
permissible to shower and bathe
following your surgery. Avoid
getting the wound soaking wet.
Follow-up appointment. You
should call our office to set up a
postoperative visit for one week
following your surgery.
