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Medical Author:

James K. Bredenkamp, MD, FACS

James K. Bredenkamp, MD, FACS

Dr. Bredenkamp recieved his medical degree from the University of California, San Francisco School of Medicine. He then went on to serve a six year residency at the University of California, Los Angeles School of Medicine in the department of Surgery.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• What are the parathyroid glands?
• What is a parathyroidectomy?
• What is hyperparathyroidism?
• What causes hyperparathyroidism?
• When is a parathyroidectomy necessary and how is it performed?
• What are the risks of parathyroidectomy?
• What are the possible complications of parathyroidectomy?
• What else do you need to know before parathyroidectomy?
• What about care after parathyroidectomy?
• When should I contact the doctor?
• Parathyroidectomy Index

What are the risks of parathyroidectomy?

The anatomy of the parathyroid glands is complicated by two important structures: the recurrent laryngeal nerve and the thyroid gland. The recurrent laryngeal nerve is a very important nerve that runs very close to or through the thyroid gland next to the parathyroid glands. This nerve controls movement of the vocal cord on that side of the larynx , and damage to the nerve can weaken or paralyze the vocal cord. Weakness or paralysis of one vocal cord causes a breathy weak voice, and difficulty swallowing thin liquids. Weakness or paralysis of both vocal cords causes difficulty breathing. In most situations, a special breathing tube is used that rests in the larynx (voice box) between the vocal cords and is designed to allow for the continued monitoring of their function. In rare situations, the parathyroid adenoma is found within the thyroid gland, and it is necessary to remove the thyroid gland as well. The main goal of the parathyroidectomy operation is to remove the offending gland(s) while protecting the remaining normal parathyroid glands as well as the recurrent laryngeal nerves and the thyroid gland.

Surgery may be unsuccessful, that is, the hyperparathyroidism may not be cured and there may be complications of the surgery. Because individuals differ in their response to surgery, their reaction to the anesthetic and their healing following surgery, there can be no guarantee made as to the results or the lack of complications. Furthermore, the outcome of surgery may depend on preexisting or concurrent medical conditions.

What are the possible complications of parathyroidectomy?

The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. They are listed here for your information only, not to frighten you, but to make you aware and more knowledgeable concerning parathyroidectomy. Although many of these complications are rare, all have occurred at one time or another in the hands of experienced surgeons practicing community standards of care. Anyone who is contemplating surgery must weigh the potential risks and complications against the potential benefits of the surgery or any alternative to surgery.

1. Damage to the recurrent laryngeal nerve with resultant weakness or paralysis of the vocal cord or cords: This is a rare but serious complication. Unilateral weakness results in a weak, breathy voice, and there will be problems swallowing. A second surgical procedure can alleviate many of the symptoms of unilateral vocal cord paralysis. Bilateral vocal cord paralysis results in a relative normal voice; however, there is difficulty breathing, and the patient may ultimately require a tracheotomy. Every effort is made to protect the recurrent laryngeal nerve. Temporary vocal cord weakness occurs much more frequently than permanent vocal cord weakness, and it usually will resolve after several days or within a few weeks. Rarely, a malignant tumor has already invaded the nerve and has caused vocal cord weakness or paralysis.

2. Bleeding or hematoma: In rare situations, a blood transfusion may be necessary because blood is lost during surgery. Patients can choose to have autologous blood (their own blood) or blood from a friend or relative collected in advance of the surgery in case a transfusion is necessary. The surgeon can make arrangements for patients interested in these options.

3. Damage to the remaining parathyroid glands with resultant problems in maintaining calcium levels in the blood: In most situations, you only need one functioning gland to have normal calcium levels. In the rare event that all glands are removed, blood calcium levels may fall, and patients may need to take calcium supplementation for the rest of their lives.

4. Need for further and more aggressive surgery: In some cases, surgical exploration fails to identify the abnormal parathyroid gland or multiple abnormal glands may be present. Further and more aggressive surgery may be necessary, such as an extensive surgical exploration of the neck or chest.

5. Need for a limited or total thyroidectomy: In rare situations, the abnormal parathyroid gland is within the thyroid gland itself or an unexpected thyroid carcinoma, a malignant cancer, is identified. In such situations, much or all of the thyroid gland must be removed, and there may be a need for life-long thyroid hormone treatment.

6. Prolonged pain, impaired healing, need for prolonged hospitalization, permanent numbness of the neck skin, poor cosmetic result, and/or scar formation.

7. Recurrence of the tumor or failure to cure the tumor despite effective therapy.