Parathyroid surgery: Recovery
What is the recovery like?
How long will I stay in the hospital?
Parathyroid surgery can be done as an overnight hospital stay or as outpatient surgery (i.e. ambulatory or same day surgery). This decision is based upon many factors including the surgeon's comfort level with managing patients at home and your overall health. Following surgery you will be brought to the recovery room. You will be monitored by the nursing staff and the physicians for a period of time in the range of about 4 to 8 hours. During that time you will recover from the anesthesia. Your ability to swallow and speak normally will be assessed and your neck will be monitored for any signs of bleeding. These include swelling, pain, and difficulty breathing. At the end of the observation period, you will either be transferred to a bed in the hospital or evaluated for discharge to home depending on what you and your surgeon have planned. If you stay in the hospital overnight, you will be monitored for signs of bleeding in the neck and your blood calcium levels will likely be checked the next morning. You will usually be sent home the day after surgery if you meet the discharge criteria (ability to speak, swallow, urinate, tolerate food, adequate pain control and no neck swelling). If you are to be sent home the day of the operation, you will be evaluated and allowed to go home with a family member or other designated chaperone if you meet the same discharge criteria.
Will I have pain after the operation?
As with any operation, you will have some discomfort after the operation. Most patients feel as if they have a sore throat from a bad cold. You should be able to swallow anything after the operation, but most people prefer softer foods for the first few days. The hardest thing to swallow will be water and liquids. The easiest thing to swallow will be semisolid foods such as ice cream or oatmeal. Most patients take pain medicine for 2 or 3 days following the surgery. Many patients will get by with Tylenol or Motrin, but will also receive a prescription for a painkiller with a little narcotic medication upon discharge from the hospital.
Will I need to take any new medications?
You may be instructed to take supplemental calcium after surgery depending on your individual surgeon's practice. Following parathyroid surgery some patients will experience symptoms of low calcium which include numbness and tingling in the finger tips and around the lips. (see Risks of Parathyroid Surgery) The treatment for this is to take calcium pills (and occasionally vitamin D pills) by mouth. Patients that undergo outpatient surgery may be sent home on routine calcium supplementation for the first week to prevent the potential symptoms of low calcium. Patients admitted to the hospital may be prescribed calcium supplementation based upon the results of blood tests. Most surgeons and endocrinologists keep patients on calcium supplementation (1 -2 grams daily) for up to a year following surgery to help improve bone strength.
When can I return to normal activity/work?
The amount of time until you can return to work and normal activity depends on the individual patient, the extent of surgery, and the surgeon's recommendations. In general, most patients take several days off from work or their normal activity following parathyroid surgery. A week away from work is nice, but probably not necessary unless you are performing heavy lifting or lots of physical activity. Showering instructions are specific to the type of closure and dressing applied. You can drive a car when you are no longer taking narcotic pain medication and you are able to turn their heads fully from side to side. Most surgeons will ask you not to fly within 24 hours to 1 week of the surgery.
What will the scar look like?
Each patient heals differently, but neck incisions generally heal with a better cosmetic result than other parts of the body, especially if the surgeon is able to place the incision in a natural crease or skin line in the neck. The length and location of the incision may depend upon the location of the parathyroid gland being removed. Surgeons can make the smallest incisions in patients with thin long necks who present with a well-localized abnormal parathyroid gland on preoperative imaging. The acute inflammatory phase lasts for about 2 to 3 weeks after the surgery. During that time the incision is often pink. Slowly over the next several months the pink color will fade into a thin white line. In many patients the scar is barely noticeable, especially if it has been placed in a natural crease and is symmetrical with respect to the midline of the neck. Many patients rub commercially available ointments or vitamin E into the incision. There is likely no real benefit to this practice, but it is also likely not harmful. Neck incisions will darken if exposed to the sun, which can be avoided by applying sun block. Skin closure by a plastic surgeon is generally not beneficial. Patients that are known to develop keloids may benefit from steroid injection into the skin at the time of closure.
What kind of follow-up care do I need?
You should schedule a follow-up appointment with your surgeon as he or she instructs. Your doctor will discuss pathology results from surgery as well as let you know when you have fully recovered from your surgery. Typically you will have blood calcium and parathyroid hormone (PTH) levels checked at the post-operative visit and 6 months after the operation. You should have your calcium levels checked at least once a year. If you had evidence of bone loss prior to surgery, you should have a bone density (DEXA) scan done one year after the operation. If you have any additional questions or concerns you should discuss these with your doctor.