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PatientInformationLeafletP2

POTENTIALCONSEQUENCESOFPARATHYROIDSURGERY

Parathyroidsurgeryisgenerallyasafeprocedure.Thevastmajorityofpatients

undergoinganoperationontheparathyroidglandhavenocomplications.

However,aswithanysurgicalprocedure,therearesomerisksassociatedwith

theoperationandtheseshouldbefullyexplainedtoyoubyyoursurgicalteam.

RecurrentLaryngealnerve‘Voicenerve’

Thyroidgland

Parathyroidglands

Clavicle‘Collarbone’

Sternum‘Breastbone’

SuperiorLaryngealnerve

Larynx’Adam’sapple’

Voicechanges

Therearethreepossiblereasonsforsuchchangestooccur:

Injurytotherecurrentlaryngealnerve(s)

Therearetworecurrentlaryngealnerves,oneoneachsideoftheneck.They

passbehindthethyroidglandandintothelarynx(voicebox)wheretheycontrol

movementsofthevocalcords.

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If“bruised”,thenervedoesnotworkproperlyimmediatelyaftersurgerybut

recoversandshouldreturntonormalfunctionduringthenextfewdaysor

weeks.Sometimes,however,itcantakeuptoafewmonthsforthevoiceto

returntonormal.

Permanentdamagetooneofthesenerves(risk:approximately1in100)causes

ahoarse,croakyandweakvoice.Thebodyusuallyadaptstothedamageand

symptomsmaygetbetterwithtime.Ifvoiceproblemspersistformorethan

threemonthsyouwillbereferredforvoicetherapy.Sometimesfurtherspecialist

surgeryisrequiredtoimprovethevoice.

Permanentdamagetobothnervesisveryrareindeedbutisaseriousproblem

thatmayhavetobetreatedbyputtingapermanenttracheostomy(breathing

tube)intothewindpipeintheneck.

Non-specificvoicechanges

Anyoperationontheneckcanproducesomechangeinthevoiceevenwhen

thereisnoinjurytothenervescontrollingmovementofthevocalcords.

Fortunatelythisvoicechangeisnotnormallynoticeableandrecoverswithina

fewmonthsoftheoperation.Youmightfindyourvoiceisslightlydeeperand

youmightexperiencevoicefatigue.Thisissignificantmainlyforthosewhouse

theirvoiceforprofessionalreasons.

Lowcalciumlevels

Insomecases,afterparathyroidsurgery,calciumlevelsmaydroptoolow.Thisis

almostalwaystemporarywhilstthebodyregainsbalanceofcalciumlevels.Your

surgicalteamwillcheckforthispostoperatively.Ifyoufeeltinglingorspasmsin

yourlips,fingersortoesaftertheoperation,thenthiscouldbeanindicationthat

yourcalciumlevelsmaybelow,andyouwillneedtoseekattentionfromyourGP

oryoursurgicalteam.Youmaybeprescribedcalciumtabletstemporarily.

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CalciumLevelsRemainingHighDespiteSurgery

Occasionally,inaround3to5operationsoutofevery100,thebloodcalcium

levelsremainhighdespitepatientsundergoingsurgery.Thisindicatesthatthe

operationhasnotbeensuccessfulincuringthecondition.Yoursurgeonwillnow

explainwhathappensnext.Thismayinvolverepeatingthetestsandscansyou

havealreadyhadtoseeiffurtherinformationmaybegained.Occasionally,more

involvedtestsarerequired,andifthisisthecaseyoursurgicalteamwillexplain

thesetoyou.

Bleedingaftertheoperation

Thisisanuncommoncomplicationthatcanleadtoneckdiscomfortor,inmore

severecases,breathingdifficulties.Occasionally,patientswillneedtoreturnto

operatingtheatreandhavefurthersurgerytohavetheneckexploredsothatthe

causeofbleedingcanbedealtwith.

NeckNumbness

Somepatientsmayexperiencenumbnessaroundthesurgeryscaraftertheir

operation.Thisusuallysettlesinthefullnessoftime.

Swallowingdifficulties

Followinganeckexploration,youshouldbeabletoeatanddrinknormally,but

somepatientsfeelasthoughthereisalumpintheirthroatastheyswallow.This

iscommonandwilldisappearintime.

Scar

Sometimesthescarmayberedforafewmonthsaftertheoperationbefore

fadingtoathinwhiteline.Ittakesaboutsixmonthstooneyearforthescarto

reachitsfinalappearance.Somepatientsmaydevelopathickexaggeratedscar

whichisunsightlybutthisisveryrare.

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Woundinfection

Infectionisnotcommonbutifithappensitcanbetreatedwithantibiotics.

Wouldswelling

Somedegreeofswellingaroundthewoundisnormalfollowinganytypeof

surgeryincludingparathyroidoperations.

RisksofGeneralAnaesthesia

Modernanaesthesiaisverysafeandseriousproblemsareuncommon.All

anaesthetistsintheUKarefullyqualifieddoctorswithspecialisttraining.

Itisnotuncommonafterananaestheticforsomepatientstofeelsickandfor

sometovomit.Certainpeoplearemorepronetothisproblem,andyour

anaesthetistwillgiveyoumedicationthatdecreasesthechanceofthis

happening.Otherproblemsthatcanoccurincludesorethroat,dizziness,blurred

vision,headache,itching,aches,painsandbackache.Theseproblemstendtoget

betterwithinafewhoursofwakingup.

Lesscommonproblems(1in1000patients)includedevelopmentofachest

infection(particularlyinthosewhoalreadyhavechestcomplaints),muscle

pains,damagetoteeth,lipsortongue,ortheworseningofanexistingmedical

condition.

Veryuncommonproblems(1in10,000patients)includedamagetotheeyes,a

seriousdrugallergyandnervedamage.Theriskofawareness(remaining

conscious)whilstunderageneralanaestheticisveryuncommon(also1:10,000).

Whenawarenessdoesoccur,itistypicallyforashortperiodpriortothe

operationcommencing.Itisextremelyraretobeconsciousduringtheoperation.

Therisktoyouasanindividualwilldependonwhetheryouhaveanyother

illness,personalfactors(suchassmokingorbeingoverweight)orsurgerythatis

complicated,takesalongtimeorisdoneinanemergency.

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Pleasediscussanypre-existingmedicalconditionswithyouranaesthetist.In

certainsituationsyouranaesthetistmaywanttoseeyouafewweeksbefore

youradmissiondatetomakesuretherearenoproblemsthatneeddealingwith

beforeyouroperation.

Formoreinformationaboutrisksassociatedwithyouranaestheticyoucan

eithercontactyourAnaesthetistthroughyoursurgicalteamorvisittheRoyal

CollegeofAnaesthetistswebsiteatwww.rcoa.ac.uk.

TheBritishAssociationofEndocrine&ThyroidSurgeonsisindebtedtoDrAdamDobsonConsultantAnaesthetist,UniversityHospitalofSouthManchesterwhohelpedintheproductionofthisleaflet

Disclaimer

Theadviceinthisleafletisbelievedtobetrueandaccurateatthetimeofgoingtopress.

Ultimately,theresponsibilityforobtaininginformedconsentfromyouforasurgicalprocedure

lieswithyoursurgicalteamandnotwiththeBritishAssociationofEndocrine&Thyroid

Surgeons(BAETS).

BAETScannotacceptanylegalresponsibilityforthecontentsofthisleafletwhichisproducedin

goodfaith.