Parathyroidectomy: what happens, risks and recovery

Four tiny parathyroid glands behind the thyroid control calcium. In primary hyperparathyroidism one or more becomes overactive, usually from a non-cancerous adenoma, according to the NHS, and calcium in the blood rises. The NHS says untreated disease can lead to osteoporosis, kidney stones and high blood pressure, and that people are offered surgery to remove part or all of the glands.

Surgery is not obligatory for everyone. BAETS explains that medicines can control the high calcium but only provide temporary benefit, and the NHS says specialists may offer medicine if you decline surgery or it is unsuitable. If tests show only mild changes and you have no complications, your endocrinologist may suggest a monitoring period before deciding.

The aim of preparation is to prove the diagnosis and find the gland. BAETS lists blood and urine tests, ultrasound of the neck and kidneys and nuclear or CT imaging, and says MRI or PET may be added in some people. Surgeons use the pictures to decide between a targeted and a wider operation.

Pre-assessment for the general anaesthetic covers fasting, medicines and any history of kidney stones or bone problems. The NHS warns against making dietary changes for this condition without specialist advice, so ask your team about calcium intake and fluids rather than guessing.

BAETS says the operation is under general anaesthetic. In a focused (minimally invasive) operation the surgeon removes only the gland that scans identify. In a bilateral neck exploration the surgeon examines all four glands through an incision it gives as 5 to 7 cm, and removes those that are abnormal.

BAETS notes that a focused parathyroidectomy can be done as a day case in some centres, and that the length of stay varies with the type of operation and hospital policy, so ask your team what to plan for.

The leaflets reviewed describe a fall in calcium after surgery as the main concern. BAETS says blood calcium may fall too low and that calcium and vitamin D tablets are given if needed. Other risks are those of any neck operation: bleeding, infection, scar problems and, rarely, injury to the voice nerve; the BAETS thyroid consequences leaflet describes how nerve injury may affect the voice.

If calcium stays high afterwards, your specialist will discuss further tests or treatment. No complication percentages were found in the pages retrieved for this guide, so none are quoted; ask for your surgeon's own results.

BAETS suggests office work after two to three weeks and heavy work after about four, and says driving is fine once you can make an emergency stop safely. The neck is sore rather than severely painful, and a small scar fades over time. GOV.UK expects you to stay off the road when you cannot control a vehicle safely and says to tell the DVLA if you are still unable to drive three months after an operation.

Blood calcium is normally rechecked afterwards, and your team will explain when and where. Ask how the results will be shared with your GP.

BAETS advises contacting your GP if you develop tingling or spasms in the lips, fingers or toes, which can signal low calcium; if it is severe or you have cramps, seek urgent help. Rapid neck swelling or trouble breathing needs 999. A hot, red or leaking wound should be reported to the surgical team or NHS 111.

• Have the scans found the gland, and is a focused operation possible?

• What happens if the surgeon needs to look at all four glands?

• How will calcium be tested after the operation, and for how long?

• Will I be a day case or stay overnight?

• What is the plan if calcium stays high?

Operations are the same in both settings. The NHS typically passes you through endocrinology and a specialist surgical team, which may have a waiting list; a private surgeon may offer earlier dates and choice of centre. Ask how much parathyroid imaging is included and who reviews your calcium after the operation.