Patient Information Leaflet P1 - · PDF filePatient Information Leaflet P1 ... , contact your...
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1 Patient Information Leaflet P1 Parathyroid Operations in Adults What are the Parathyroid glands and what do they do? Usually, you have four parathyroid glands. These are located between the thyroid gland and the windpipe, two on each side. In healthy adults, each parathyroid gland is usually 3-4 mm in size. They are responsible for the secretion of a hormone (the parathyroid hormone, PTH) which is required for the regulation of calcium in the body. Recurrent Laryngeal nerve ‘Voice nerve’ Thyroid gland Parathyroid glands Clavicle ‘Collar bone’ Sternum ‘Breast bone’ Superior Laryngeal nerve Larynx ’Adam’s apple’ Reasons why patients may need parathyroid surgery One common cause of high calcium in the body is due to an abnormal parathyroid gland which is ‘over-functioning’ and producing too much PTH. In the majority of patients, this is due to a single abnormal parathyroid gland (Primary Hyperparathyroidism). In some instances, more than one gland is involved.
Transcript of 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.
