Parathyroid Surgery Risks and Complications
Every surgery has potential risks and complications. You can minimize the chance of complications by selecting an experienced parathyroid surgeon. The risks of surgery are weighted against the risks of not having the surgery performed. The primary risk in parathyroid surgery is hoarseness from trauma to the recurrent laryngeal nerve. This complication may occur in approximately 1 in 100 parathyroid surgeries. Although this is usually temporary, it may be permanent. The recurrent laryngeal nerve that controls the voice box passes next to the thyroid and parathyroid glands. Frequently this nerve needs to be dissected away from the parathyroid glands and this dissection may result in hoarseness or permanent injury.
In experienced hands, hyperparathyroidism is cured in 98% of surgical cases. However, there is a small percentage of patients where hyperparathyroidism persists. This may be due to either multiple parathyroid tumors or due to difficulty in finding the parathyroid tumor in the usual locations. These tumors may occur in the chest or behind the esophagus and as such may not be amenable to removal based on the originally planned surgical approach.
There is a small risk of bleeding in the wound after parathyroid surgery. You can usually determine this by excessive swelling and/or bleeding at the wound site. If this happens, you should immediately contact your parathyroid surgeon. Wound infections are relatively uncommon and can be easily treated with antibiotics. Wound infections after parathyroid surgery are usually manifest by redness and tenderness around the wound that does not improve with time.
Listed below are some of the possible parathyroid surgery complications. Risks include, but are not limite to:
- Permanent voice hoarseness <1%
- Failure to cure the hyperparathyroidism <2%
- Persistent hypercalcemia <1%
- Wound infection <1%
- Hematoma or bleeding <1%
- Swelling or black/blue <4%
- Hypocalcemia <1%
- Other unforseen risks
You will also require an anesthetic. Risks of serious complications in a healthy person are very rare. Potential risks of anesthesia include, but are not limited to:
- Heart problems (death, heart attack, arrhythmias)
- Lung problems (pneumonia, wheezing)
- Blood clots (stroke, clots in the leg veins or lungs)
- Drug reactions
- Chipped teeth
- Other unforseen risks.
Hypocalcemia after Parathyroid Surgery
In about 10% of patients who have parathyroid surgery, the remaining parathyroid glands do not function well immediately after surgery. This is because the one overactive gland caused the others to be supressed and therefore not secrete sufficient parathyroid hormone (PTH) for the body's needs. This is usually temporary. Symptoms include numbness and tingling in the hands, feet and around the lips. This usually occurs within the first 72 hours of surgery and is most commonly temporary. You can treat this by taking extra calcium with vitamin D pills. If you do experience these symptoms, you should call your physician to let him or her know.
Bleeding may occur if you have an underlying bleeding disorder or you have taken a medication that prevents coagulation. Aspirin, Ibuprofen, Advil, Coumadin, Plavix and other medications that can cause bleeding, prevent coagulation or "thin the blood" should be strictly avoided preoperatively. Aspirin and Advil need to be stopped at least one week before surgery. If you must remain on an anticoagulant you should consult with your internist or cardiologist who should then send their report to us.
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