Risk of Parathyroidectomy

The risk of parathyroid surgery is minimal. The risk of a serious complication is significantly less than 1%. Like other surgery, there are risks with anesthesia, bleeding and infection. These are quite small.

As with thyroid surgery there is a risk of voice injury. This is rare. The superior parathyroid glands may be very close to the recurrent nerve but the inferior glands are well away from this nerve. The risk of a permanent voice problem is truly rare, but not zero. A more significant issue is the possibility of failure to cure. Over all the the cure rate approaches 98%, but each patient has to be emotionally prepared for the unlikely  outcome that they may have persistent disease after the operation. This may be due to misleading results from an imaging study or from incorrect PTH monitoring information or sometimes we just can’t find the adenoma. As mentioned earlier, HPT due to hyperplasia has a higher risk of recurrent disease so the cure rate is closer to 90%. If persistant HPT is present after surgery, we have a strategy to deal with it. First we confirm the diagnosis, then a series of increasingly complex imaging studies are performed to try to find the missing parathyroid gland. If the abnormal gland is located then a directed surgical approach is planned. It is very uncommon to under take blind repeat neck exploration. Each case is considered individually.

Hypoparathyroidism is a risk of parathyroid surgery. Generally, this is not a concern when an adenoma is the problem. Though on occasion, temporary hypocalcemia may occur if calcium is resorbed to quickly into the bone after removal of the adenoma. Temporary treatment with calcium supplements and vitamin D and magnesium may be needed. However, if the patient has HPT caused by hyperplasia ( multi-gland disease) then it is possible that the remaining parathyroid gland might not function. The risk of permanent hypoparathyroidism in our patients following subtotal parathyroidectomy is about 2% If a total parathyroidectomy is performed with auto-transplantation it is possible that the re-implanted parathyroid tissue may not re-grow when it is placed in the muscle. The medical literature suggest this occurs up to  10% of cases. Our experience suggest this is significantly less likely.