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

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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