Before and After Parathyroid Surgery
Before Your Clinic Visit:
Before you see the surgeon, you may need to undergo a series of tests to evaluate your parathyroid glands. Testing may include an ultrasound, a sestamibi scan and/or a CT scan. These tests provide useful information to the surgeon about your parathyroid glands. You will also have routine blood work. Depending on your blood work results, some people may need to take vitamin D before surgery.
Prior to having surgery, a series of general screening tests are done to make sure you are healthy for surgery. These are often conducted 1-2 weeks before the operation and may include blood work as well as a thorough history and physical exam. Depending on your history, you may also need an EKG, chest x-ray, and/or stress test. These tests evaluate your heart and lung function. They do not require a hospital stay. Depending on your age and health, you may see a high-risk anesthesiologist, your primary care doctor or the surgeon for these tests.
Prior to surgery, you may also meet with an endocrine nurse practitioner who will educate you about the operation and make sure all the appropriate testing has been completed.
PLEASE ASK your doctor or surgeon BEFORE stopping or changing any of your medications.
Medication Guidelines Prior to Surgery:
Certain medications may need to be stopped before surgery. Please consult your surgeon or primary care physician before stopping any of your prescribed medications.
Cardiac medications (blood pressure medications): DO NOT take on the day of surgery:
- Benazepril (Lotensin)
- Bumetanide (Bumex)
- Candesartan (Atacand)
- Captopril (Capoten)
- Enalapril (Vasotec)
- Eprosartan (Teveten)
- Fosinopril (Monopril)
- Furosemide (Lasix)
- Hydrochlorothiazide (HCTZ)
- Iosartan (Cozaar, Hyzaar)
- Irbesartan (Avapro)
- Lisinopril (Prinivil, Zestril)
- Metolazone (Zaroxolyn)
- Olmesartan (Benicar)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Ramipril (Altace)
- Spironolactone (Aldactone)
- Telmisartan (Micardis)
- Valsartan (Diovan)
Blood thinners: Please make sure you have discussed this with your physician or surgeon before stopping these medications.
- Aspirin – Stop taking 7 days before surgery
- Coumadin – Stop taking 5 days before surgery
- Heparin – Must be held for 12 hours prior to surgery
- Antiplatelet agents (Plavix, clopidogrel, ticlopidine) – Please follow your surgeon or cardiologist’s recommendations.
Insulin – Patient with insulin pumps:
- Continue your basal rate ONLY
Patients without insulin pumps:
On the morning of surgery:
- Hold short acting insulin
- Pre-mixed insulin (eg. 70/30): give 1/3 of usual dose
- Lantus: give usual dose
Oral diabetic medications: do not take the morning of surgery
Other prescription medications:
- MAO inhibitors – do not take the day of surgery
- Premarin – do not take on the day of surgery
- Viagra or similar drugs – do not take 24 hours before surgery
- Aspirin – stop taking 7 days before surgery
- NSAIDS (ibuprofen, Aleve, naproxen, Celebrex) – stop taking 7 days before surgery
- Iron – do not take on the day of surgery
- Herbal supplements and Vitamin E-containing multivitamins – stop taking 7 days prior to surgery
Day of Surgery
The Day Surgery department will call you the night before your surgery to let you know what time to arrive. You will be asked to come to the hospital at least two hours before your scheduled surgery time. As a general rule, you will be asked not to eat or drink anything after midnight the night before surgery. Most often you can take your routine medications with a sip of water. Medication guidelines will be discussed at your pre-operative visit.
Depending on your age, health, and difficulty of surgery, you may or may not need to stay overnight in the hospital. This is typically discussed with your surgeon during your clinic visit. Please leave all valuables at home and wear comfortable clothing.
Medications on Discharge
Common medications you may be prescribed on discharge:
- Pain medication
- Calcium (TUMS): After parathyroid surgery, all patients are discharged home with calcium supplementation. Parathyroid glands regulate calcium levels in the blood. The calcium is necessary due to removal of the overactive gland and the remaining “sleepy” parathyroid glands. The remaining glands are usually underactive for a few days after surgery. If the remaining glands are underactive, you may have low calcium levels. A low calcium level is typically a short term problem treated with calcium supplements. Signs of low calcium include numbness and tingling around the lips and in the fingers and toes. If you experience these symptoms, please notify the office.
- Vitamin D (Ergocalciferol, calcitriol): If your Vitamin D levels are low before surgery, you will be given a supplement to take. After surgery, you may require a different form of Vitamin D (calcitriol) because your parathyroid glands may produce a low amount of parathyroid hormone, which will make your calcium levels low. This is not always necessary in all patients.
Approximately 1-2 weeks following surgery, you will return to clinic to meet with your surgeon. At this time you will also meet with a nurse or nurse practitioner who will review instructions regarding care for your incision. You will also have some blood work checked. Depending on the results of the blood work, you may need to take additional calcium supplementation for a short period of time.
Questions you may have regarding your surgery:
What is the recovery like?
You should expect to return to work within 1-2 weeks. Typically recovery from surgery is short and pain is minimal. The most common complaint following surgery is fatigue, a sore throat and generalized soreness which usually resolves within a week or two.
When can I go back to work?
You may return to work when you feel you are able. Some people will go back after a few days and some take up to two weeks.
When can I eat? What can I eat?
You may eat after surgery. There are no restrictions on what you may eat or drink. Some people experience a sore throat and prefer soft foods for a few days. It is recommended that you avoid heavy, greasy or spicy meals for the first few days.
What activities can I do?
You may resume your normal activities after surgery. There are no restrictions. You may feel more tired than usual which should resolve in a reasonable time after surgery. Light activity, like walking, is encouraged to help speed up recovery. Gentle neck exercises (PDF) will help prevent neck stiffness.
When can I talk again?
You may talk immediately after surgery. Your throat may be sore but talking is highly encouraged.
How do I take care of the dressing over my incision?
Typically, Steri-Strips are placed over the wound. These are small strips of white tape which help to protect the incision. The Steri-Strips should remain intact for about 7-10 days. You may take them off after a week.
When can I shower?
You may shower 24-48 hours after surgery. We recommend that you leave the Steri-Strips intact while you shower and lightly dry them off with a towel when you are finished. You should avoid swimming, baths and hot tubs for at least 2 weeks following surgery.
What can I take for pain?
When you are discharged home from the hospital, you will receive a prescription for a pain medication. Do not take pain medication and Tylenol together. The pain medication contains Tylenol. If you wish, you may take ibuprofen, but no sooner than 5 days after surgery.
What will the scar look like?
Most scars will become soft, flat white lines over time.
Why is my scar red?
You will notice during the first few weeks after surgery that the scar area will become red, firm and hard. Scars often seem to become worse before they get better. This is normal. After about 6 weeks, the scar will begin to “mature”. This means that the scar will soften and become less red. Over the next 4 months, the scar will slowly become soft and will not be as red. It may take up to a year for the scar to mature.
When will the scars go away?
A scar is usually permanent. As the scar become softer and less red, it will begin to blend into the skin around the scar. It will become less visible.
Does putting Vitamin E oil on the scar help?
It is not known for sure if Vitamin E oil helps scars heal faster or makes them less visible. If you choose to use Vitamin E oil on the scar, it won’t hurt. Applying any oil or lotion that can add moisture to the skin will help. Two weeks after surgery, it is a good idea to massage a scar gently but firmly for 5 minutes, two to four times per day. Use oil or lotion of your choice when doing the massage.
What about sunlight and scars?
It is important to keep out of direct sunlight for up to one year after surgery. Too much direct sunlight makes a scar darker in color than the skin around the scar. You should use sunscreen with at least SPF 15 when outdoors.