Patient Information Leaflet P1 - · PDF filePatient Information Leaflet P1 ... , contact your...
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PatientInformationLeafletP1
ParathyroidOperationsinAdults
WhataretheParathyroidglandsandwhatdotheydo?Usually,youhavefourparathyroidglands.Thesearelocatedbetweenthethyroidglandandthewindpipe,twooneachside.Inhealthyadults,eachparathyroidglandisusually3-4mminsize.Theyareresponsibleforthesecretionofahormone(theparathyroidhormone,PTH)whichisrequiredfortheregulationofcalciuminthebody.
RecurrentLaryngealnerve‘Voicenerve’
Thyroidgland
Parathyroidglands
Clavicle‘Collarbone’
Sternum‘Breastbone’
SuperiorLaryngealnerve
Larynx’Adam’sapple’
ReasonswhypatientsmayneedparathyroidsurgeryOnecommoncauseofhighcalciuminthebodyisduetoanabnormalparathyroidglandwhichis‘over-functioning’andproducingtoomuchPTH.Inthemajorityofpatients,thisisduetoasingleabnormalparathyroidgland(PrimaryHyperparathyroidism).Insomeinstances,morethanoneglandisinvolved.
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PTHactsonthekidneys,boneandgastrointestinaltract(stomachandbowel)toincreasethecalciumintheblood.Althoughhighcalciummaybeassociatedwithsymptoms,manypatientshavetheirhighcalciumdetectedcoincidentallyonroutinebloodtests.Symptomsthatmaybeassociatedwithhighcalciumcaninclude:
• muscleweaknessandfatigue• changesinyourheartrate• weightloss• excessivethirst• changesinurinaryfrequency• dehydration• stomachulcers• kidneystones• fractures
Eveninpatientswhodonothavesymptomsduetohighcalcium,parathyroidsurgeryisrecommended,assurgerydecreasesthelong-termeffectsonthebonesandkidneys.Whatarethealternativestosurgery?Medicationdoesexisttocontrolthehighcalciumintheblood.Youmayalreadyhavediscussedtheseoptionswithyourendocrinologistpriortoreferraltothesurgicalclinic.Medicaltreatmentisgenerallyoftemporarybenefit,anddoesnotaddresstheunderlyingproblemoftheoveractiveparathyroidgland.WhattestswouldIexpecttohavebeforesurgery?Priortoreferraltothesurgicalclinic,bloodandurinetestsarelikelytohavebeenperformedbyyourendocrinologist.Inadditiontothis,allpatientswouldneedtohaveanultrasoundscanoftheneckandkidneys.AspecializedscancalledtheSestamibiscanwouldalsoberequiredinthemajorityofcircumstances.Fortheminorityofpatients,aCTscanoranMRIscanmayberequired.WhattypeofparathyroidoperationsshouldIexpect?Theoperationisperformedunderageneralanaestheticsoyouarecompletely‘asleep’.
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Therearegenerally2approachestoparathyroidsurgeryOpenOperationAlsocalledcervicalexplorationorbilateralneckexploration.Thesurgeonwillmakeasmallincision(5to7cmor2to3inches)inyourneckinordertoperformthesurgery.Theadvantageofthistypeofsurgerywouldbetoensurethatallfourparathyroidglandsareinspected,andthediseasedglandisremoved.FocusedOperationAlsoknownasminimallyinvasiveapproachorkeyholeapproach.Theuseofthepreoperativescanshasallowedmoreaccurateidentificationofthediseasedparathyroidglandinsomepatients.Thus,inthesepatientsasmallerscarcanbeused.Onlytheglandidentifiedtobediseasedonthescan(s)isremoved.Yoursurgeonwillexplainwhichoneyouareadvisedtoconsiderandwhy.Inbothcases,thewoundisthenstitchedwithdissolvingstitchesorremovablestitches.Itwillhealtoformascar.Whatwillhappenpriortosurgery?Ifyouareonregularmedications,youshouldcontinuetheseunlessadvisedotherwise.Somesurgeonsmayaskyoutostoptakingmedicinessuchasaspirin,dipyridamole(Persantine)orclopidogrel(Plavix)inthedaysleadinguptoyouroperation.Ifyouareonanyofthesetablets,discussthiswithyoursurgeon.Patientsonblood-thinningtablets(suchaswarfarin,rivaroxabanordabigatran)shouldinformtheirsurgeon.HowlongwillIbeinhospital?Thisdependsverymuchonwhatprocedureyouhadandthehospital’slocalpolicies.Yoursurgeonwilladviseyouaccordingly.CareofyourwoundWhenyouaredischargedfromhospitalyoucanexpecttobegivenadviceaboutcareofyourwoundfromthewardstaff.Thewoundmaybecoveredbyadressingandthiscanusuallyberemovedafter48hoursunlessyouaretold
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otherwise.Youwillusuallybeabletotakeabathorshower48hoursafteryouroperation.Gentlypatyourwounddryratherthanrubit.Yourwoundmaybeslightlyraisedandpinkorredinthedaysfollowingsurgery.Thiswillsettleovertimeasitheals.Eventuallythewoundshouldbecomeflatandpalebutthismaytakeseveralmonths.Unlesssuggestedbyyourmedicalteam,itisnotadvisabletorubanyointmentsorbio-oilsontothewoundimmediatelyafteryoursurgerybeforethewoundhashadchancetoheal.Itisbesttowaituntilyouhavebeenseeninthepost-operativeclinicanddiscusswithyoursurgeonifyouwishtousesuchproducts.WhatcanIexpectaftertheoperation,andhowsoonwillIrecover?Itisnormaltofeeltiredfollowingparathyroidsurgery.Thesymptomsoftirednessthatyoumayhavehadpre-operativelymaytakeafewweekstoresolve.Insomecases,followingparathyroidsurgery,thelevelsofcalciuminyourbloodcanfalltoolow.Thisiswhilethebodyregainscontrolofcalciumbalanceinyourbloodstream.Yoursurgicalteamwillcheckforthisonpostoperativebloodtestsandyoumaybeprescribedcalciumtabletsshouldtheselevelsfalltoolow.Ifyoufeeltinglingorspasmsinyourlips,fingersortoes,contactyourGPasthiscanbeasignthatyourbloodcalciummayhavefallentoolow.Followinganeckexploration,youshouldbeabletoeatanddrinknormally,butsomepatientsfeelasthoughthereisalumpintheirthroatastheyswallow.Thisiscommonandwilldisappearintime.Beforeresumingdrivingyouneedtoensurethatyoucanmakeanemergencystopwithouthurtingyourneck.Youalsoneedtobeabletocomfortablyturnyournecktolookaroundasyoudrive,forexample,whenyouchangelanes.Youshouldinformyourcarinsurancecompanythatyouhavehadaparathyroidoperationasdifferentinsurersmayhavetheirownrulesabouthowlongyoushouldwaitafteranoperationbeforeyoureturntodriving.Yourreturntoworkdependsonthetypeofworkyoudoandtheoperationyouhavehad.Youmaybeabletoreturntooffice-basedworkaftertwotothreeweeksandheavierworkafterfourweeks.Yoursurgicalteamwilladviseyou.
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Whatarethepossiblecomplicationsofparathyroidsurgery?Complicationsofparathyroidsurgeryareuncommon.Thevastmajorityofpatientshavestraightforwardsurgeryandaredischargedthefollowingdaywithoutanycomplications.Yoursurgeonwilldiscussthebenefitsandpotentialcomplicationsofsurgerywithyouindetail.Pleasefeelfreetoaskanyquestionsthatareonyourmind.BAETShaveproducedapatientinformationleaflet,PotentialConsequencesofParathyroidSurgery,whichcanbefoundonourwebsite(www.baets.org.uk).
BAETSwishestoacknowledgetheadviceandsupportofHypoparaUK,apatient
supportgroupthatsupportspatientswhohavepostoperativeparathyroid
problems.
ForfurtherinformationandsupportpleasevisitHypoparaUKat
www.hypopara.org.ukorcall01342316315/01623750330
Disclaimer
Theadviceinthisleafletisbelievedtobetrueandaccurateatthetimeofgoingtopress.
Ultimately,theresponsibilityforobtaininginformedconsentfromyouforasurgicalprocedure
lieswithyoursurgicalteamandnotwiththeBritishAssociationofEndocrine&Thyroid
Surgeons(BAETS).
BAETScannotacceptanylegalresponsibilityforthecontentsofthisleafletwhichisproducedin
goodfaith.