Post parathyroidectomy care

OVERVIEW

• parathyroidectomy is usually a straightforward procedure performed by an endocrine surgeon
• the parathyroid glands produce parathyroid hormone and are involved in calcium metabolism
• there are typically 4 glands, variably positioned posterior to the thyroid – but they may be present in ectopic sites

INDICATIONS

• primary hyperparathyroidism
• parathyroid mass

COMPLICATIONS

Superficial

• infection
• skin tethering to laryngeal cartilage or trachea
• scarring and keloid formation

Deep

• hematoma (rare) – may need aspiration or I&D; drains not often present
• airway compromise due to hematoma (especially if branches of the superior and/or inferior thyroid arteries and/or the internal mammary artery  are not adequately ligated)
• recurrent laryngeal nerve injury (close to ITA; hoarse or loss of voice)
• superior laryngeal nerve injury (upper pole)

Other

• disease not found (consider ectopic sites: intrathyroidal adenoma, within the thymus, within the carotid sheath, retro-oesophageal, etc)
• wrong diagnosis (e.g. familial hypocalciuric hypercalcemia and occult malignancy or other causes of hypercalcaemia)
• persistent disease (e.g. inappropriately high PTH, hypercalciuria, hypophosphataemia)

Hypocalcaemia

• more likely if an aggressive biopsy strategy used
• if other glands are inadvertently bruised, devascularised or removed
• other glands may have atrophied in response to a hyperfunctioning adenoma
• previous parathyroid or thyroid surgery may contribute
• hungry bone syndrome

MANAGEMENT

• usually a short post-op staff in an HDU setting
• monitor wound and airway
• monitor ionised calcium and for symptoms of hypocalemia
• calcium infusion may be required
• calcium and vitamin D supplements not usually needed long-term