Parathyroid surgery for primary hyperparathyroidism

Who is the leaflet for?

This information leaflet provides advice from the endocrinology perspective for patients diagnosed with primary hyperparathyroidism who will be undergoing parathyroid surgery.

Parathyroid hormone (PTH) and calcium regulation

Parathyroid hormone (PTH) is a hormone which is secreted by the parathyroid glands located in the neck. There are four parathyroid glands, two located on either side of the thyroid gland. The parathyroid glands regulate calcium levels in the blood.

Low calcium levels in the blood stimulate parathyroid hormone secretion, whereas high calcium levels in the blood prevent the release of parathyroid hormone. Calcium is essential for normal nerve conduction, heart, and muscle function. (See Figure 1, below).

Treatment/surgery

If you have a condition where your parathyroid gland is overactive (hyperparathyroidism), your blood calcium level will be raised as a result of excess PTH production. Most people (85% of patients) who develop hyperparathyroidism will have one single overactive parathyroid gland. Rarely, excess PTH can be made by more than one overactive parathyroid gland (15% of patients). Surgery to remove the overactive gland/s is the standard treatment for this condition. This is decided after careful consideration of your symptoms, imaging and laboratory tests.

After surgery, your parathyroid hormone level may take a while to normalize. In some cases, once the overactive parathyroid gland has been surgically removed, the other glands may take a few weeks before returning to normal activity. This also depends on the approach and extent of the surgical procedure. Low concentrations of PTH can cause a condition called hypoparathyroidism after surgery. This may be temporary or permanent and can cause symptoms of low blood calcium level (hypocalcaemia). Most patients will be started on calcium tablets and activated vitamin D for 2 weeks after surgery and then a blood test will be arranged. If you haven’t heard from the endocrine department within two weeks of your surgery please do contact us to arrange these tests (01223 217848).

Symptoms of hypocalcaemia

• a tingling sensation around the mouth
• facial twitching
• ‘pins and needles’
• palpitations
• muscle spasms or weakness
• stiffness and numbness

After parathyroid surgery

You will have blood tests done 12 hours after surgery and early morning the following day to monitor your calcium level.

Very occasionally, your calcium level may remain raised for a prolonged period, possibly necessitating further investigations and surgery.

Medications after parathyroid surgery

If your calcium level after surgery is normal, you will need calcium and vitamin D3 supplements for two weeks.

If your calcium level after surgery is low, you will need to continue taking calcium and vitamin D3 supplements until further advice by your endocrinology doctor. These are essential and should not be stopped until your repeat blood tests are reviewed. If you develop symptoms of low calcium despite taking these medications, please contact the endocrine service at 01223 217848.

Follow-up after discharge

You will have a follow-up appointment with the surgeon in 2-3 weeks. Your calcium levels will be re-checked, and you can discuss any concerns about your recovery. You will also have a follow up appointment with your endocrinology doctor in 6-12 weeks.

If your calcium level normalises after surgery, you can be discharged from hospital follow-up, but you will require a yearly blood test with your GP for surveillance.

For some patients, the endocrinology doctor may organise follow up bone imaging. For patients under 40 years old who are diagnosed with osteoporosis (brittle bone disease) or have significant family history of osteoporosis, genetic testing may be required to determine if the condition is hereditary.

Further information

Information and support are available from Parathyroid UK, the only patient organisation for this condition in the UK and Ireland.

Contact: See Parathyroid UK Website (opens in a new tab)