After surgery Instructions
The recovery period and what the patient should expect is outlined below. This is an overview developed after being involvedin guiding a large number of patients through their recovery.
PARATHYROIDECTOMY AFTER- SURGERY INSTRUCTIONS
You should rest for the first 24 hours after surgery. If you have any questions regarding your progress, call us right away. Dr. Larian is always available to help. If you are staying in Los Angeles, you can make an appointment at the CENTER within a week after surgery, to go over the details of your surgery and for your incision to be checked. Otherwise, we can arrange for a remote video visit.
Majority of our patients come from other cities, states and countries. The instructions below help everyone but especially those who will be leaving Los Angeles immediately after surgery
Incision
Apply an ice pack to the lower neck the first 24 hours. You can shower and wash your hair as usual the day after surgery, but do not soak or scrub the incision. You may bathe or swim 2 weeks after surgery. Please pull the tape (steri-strip) off 7 days after surgery. After the tape removal, apply vitamin E ointment twice a day and sunblock (SPF 35) in the morning for the next 2 months. Alternatively, you can use Biocorneum silicon Gel with SPF for the same 2 month period. Keeping the incision out of the sun will help it heal better.
You might notice bruising around your incision or upper chest which usually fades within a week. Swelling above the incision usually starts 3-4 days after surgery and will last for several weeks. In addition, the scar may become pink and hard. This hardening will peak at about 3 weeks and may result in some tightness, which will disappear over the next 2 to 3 months. Firm massaging of the scar starting 2 weeks after surgery will help. Massaging should be done twice daily for 5 minutes
Pain
In the majority of cases, the procedure is done under local anesthesia and the pain is minimal. Tylenol can generally control this pain. Some prefer Vicodin, but usually strong medications are not necessary. When a breathing tube is used for anesthesia, the main complaint after surgery is pain with swallowing & sore throat which again mostly can be treated with Tylenol.
NSAIDs, including Advil, Ibuprofen & Aleve should be avoided for one week after surgery.
Voice
Your voice is generally not affected because in most cases local anesthesia is used, and a breathing tube is not necessary.
Activity
Your activity level depends on the amount of discomfort you have. You can resume sports activities 2 weeks after surgery. Most patients are able to return to work in the first week. You are able to drive as soon as your head can be turned comfortably.
We encourage our patients to start going for walks twice daily the day after surgery. And gradually increase the walking time.
Low Calcium Levels After Surgery
When a person has hyperparathyroidism due to a parathyroid adenoma, the remaining normal parathyroid glands which have
not had to work much will shrink (Figure 2. below). These glands will be working but producing very little PTH at first, and gradual
improve for a few weeks until they become fully active (how much less the 3 remaining parathyroids are working can be checked during surgery by seeing how much the PTH level comes down after removing the parathyroid adenoma). This is usually temporary, generally lasting 3 weeks and can cause the blood calcium level to drop below normal (called hypocalcemia). During this time period after surgery we at the CENTER recommend our patients supplement with calcium, vitamin D and magnesium.
Symptoms of Hypocalcemia
- Numbness and tingling around the lips, in both of your hands or fingertips, or soles of both of your feet.
- Muscle cramps that last
- Some patients experience a “crawling” sensation in the skin
- Rarely severe unusual headaches
These symptoms appear between 24 and 48 hours after surgery.
Hypocalcemia Prevention
Prior to the surgery we will give you specific instructions (table below) as to how much calcium and vitamin D replacement you will need to take after surgery. This is dependent on your pre-surgery calcium levels and the number of glands that are diseased, as well as how much the PTH drops during surgery.
Some may need just Citracal Petites pills if the drop in PTH is in the normal range. If the drop is dramatic and below normal levels due to parathyroid glands being in shock then the person may need Calcium & Rocalcitrol. Dr. Larian will let you know what is appropriate for you after surgery.
Hypocalcemia Symptom Treatment
Patients with calciums of less than 14 prior to surgery: at any point if symptoms develop, you should take 8 extra Citracal Petites pills and contact Dr. Larian ASAP.
After Surgery Blood Tests
(You will be given prescriptions for these tests)
- One month & 6 months after surgery: Calcium, PTH & Vitamin D Levels.
- And then yearly thereafter
Bleeding
If bleeding occurs, you will notice immediate swelling in the neck and difficulty breathing. This is extremely rare but it is an absolute emergency. If it does occur, CALL 911 immediately.