Parathyroidectomy (cont.)

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What about care after parathyroidectomy?

After surgery, patients go to the recovery room where nurses monitor them for about one hour. In most situations patients spend one night in the hospital, although some patients undergoing a minimally invasive parathyroidectomy may go home the same day. A friend or family member usually is required to pick patients up from the surgical facility if they are going directly home. It is a good idea for someone to be at home with the patient for the first night.

Patients' necks may be swollen and bruised after surgery, and in most instances there will be a bandage wrapped around the neck. Bandages usually are removed one or two days following surgery. There may be a small plastic drain exiting through the skin. If so, the drainage of fluid from the drain will be monitored in the recovery room or hospital. Sometimes patients may even go home with a drain in place after the nursing staff teaches them how to manage the drain. Sutures taped to the neck should not be cut or trimmed.

Starting several hours after surgery and possibly for several days, blood calcium levels usually are monitored. It is not uncommon for there to be a fall in the blood calcium level following surgery. (The remaining parathyroid glands are "sleepy" following surgery.) As a result, patients may need to take supplemental oral calcium for several days or weeks following surgery. Permanent calcium problems are rare. If patients experience numbness and tingling of the lips, arms, or feet, and or twitching of the muscles--symptoms of low blood calcium--they should contact their surgeon or endocrinologist immediately. In most situations in which these symptoms occur, surgeons will ask patients to take supplemental calcium, such as in Tums-Extra Strength, after surgery. This helps to replenish calcium that is moving back into the bones.

Numbness, slight swelling, tingling, discoloration, bumpiness, hardness, crusting, tightness, and a small amount of redness around the incision are a normal findings after surgery and should improve with time. It is usually alright for patients to wash their face, neck, and hair after the bandages have been removed. Excessive scrubbing of the wound should be avoided, and a gentle soap and shampoo should be used.

In the hospital and after going home, patients generally lie in bed and rest with their head elevated on 2-3 pillows. By keeping their head elevated above their heart, swelling of the neck due to edema may be lessened. Patients get out of bed with assistance to use the bathroom, however. It is good to avoid straining when having a bowel movement, and, if constipation is a problem, a stool softener or a gentle laxative is a good idea.

It may be better to eat a light, soft, and cool diet as tolerated after recovery from the anesthetic. Even though patients may be hungry immediately after surgery, it may be best to go slowly to prevent postoperative nausea and vomiting. Occasionally, patients may vomit one or two times immediately after surgery. If vomiting persists, the doctor may prescribe medications to settle the stomach. A good overall diet with ample rest promotes healing.

Antibiotics often are prescribed after surgery. Patients should finish all the pills that have been ordered. Some form of a narcotic pain medication usually will be prescribed and is to be taken as needed. Patients who take narcotics should not drive. If there is nausea or vomiting postoperatively, patients may be prescribed medications such as promethazine (Phenergan). If patients have any questions or feel that they are developing a reaction to any of the medications, it is important that they consult with their doctor. Patients should not take any other medication, prescribed or over-the-counter, unless they have discussed it with their doctor.

Sutures are removed approximately 7 days after surgery. If not already scheduled, patients should call the surgeon's office to arrange for a follow-up visit. Routine follow-up care depends on the nature of any problems that develop. After healing has occurred, patients usually return to their endocrinologist for long-term monitoring of their calcium levels.

Patients may go back to work or school only when their doctors say they may. Patients probably should rest for the first week following surgery and avoid excessive talking, smiling, hard chewing, strenuous activities, lifting heavy objects, and bending over. Alcohol and tobacco should be avoided because they may prolong swelling and healing. Tanning is discouraged for 6 months after surgery; if patients must be in the sun they should use a number 15 or greater sun block and consider wearing a hat. Make-up may be used anytime after surgery.

After 3 weeks, if there are not problems with bleeding or excessive swelling, it is reasonable to resume exercise and swimming. To allow for postoperative care, it is probably a good idea not to travel out of town for three weeks after surgery.

Medically Reviewed by a Doctor on 2/18/2014

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