Patients recover very quickly after parathyroidectomy, After surgery for 1°HPT most patients go home the same day. However those that have 3 and 1/2 gland resections (subtotal parathyroidectomy) are usually observed overnight because of the risk of hypocalcemia. There is very little pain. All wounds are closed with skin glue and the patient may shower the next day.
All patients are given a prescription for pain medication. Many patients require only tylenol or ibuprofen. The patient should resume any medication they were on pre-op. In many patients, after surgery for 1°HPT, we recommend calcium supplements and vitamin D supplements to treat the osteoporosis associated with the disease. Usually we recommend Citracal +D. Usually 1 or 2 pills twice each day. This helps prevents temporary compensatory hypocalcemia and helps with bone remineralization. Occasionally, we also recommend magnesium supplements.
All patients are encouraged to be up and active as soon as possible after surgery. We do not want the patient to exercise or perform athletics until seen in the office post-op. Otherwise there are no restrictions on activity, but the patient should use appropriate common sense. The patient may return to work when they feel up to it and can perform their job without significant discomfort.
Low calcium (hypocalcemia) after parathyroid surgery is uncommon but may occur. It is unusual after removal of a single adenoma. Those that have a subtotal parathyroidectomy need to be observed over night to be sure the calcium level is stable prior to discharge. Some of these patients require calcium supplement and vitamin D supplements temporarily. These decisions are made on a case by case basis after surgery. Very rarely patients with severe bone disease develop “bone hunger” where, after the hyperparathyroidism is cured , the bones avidly resorb calcium from the blood leading to sometimes severe hypocalcemia that may require IV calcium. This is more common in patients with 2°HPT.
Usually, we have the patient see us in the office about 10 days after surgery. On that day, before the patient comes to the office, we have them go by the out-patient lab at the hospital for a calcium level. At the post-op visit the skin glue is removed and over-all recovery is assessed. If everything looks good then subsequent follow-up is with the referring physician. The patient should have a calcium level checked at 3 months post-op, 6 months post-op, and at 1 year post-op. Generally as long as the calcium level is normal a PTH level is not needed. This is particularly true with in the first 6 months after surgery. During this time the PTH level may be slightly elevated due to a mild degree of reactive 2°HPT from the remaining parathyroid glands as they work to re-establish a normal calcium metabolism. A PTH level taken during this time could be an source of confusion and anxiety for both the patient (and doctor) if it is elevated. However, if hypercalcemia develops at any point post-op then a complete evaluation is required. By 6 months post-op, any mild 2°HPT should be resolved so we check a PTH level then and at 1 year post-op. If both the calcium and PTH levels are normal at 1 year, the patient is considered cured.