Parathyroidectomy is a widely performed and generally safe surgery aimed at treating hyperparathyroidism—an endocrine condition in which one or more of the parathyroid glands become overactive, resulting in elevated calcium levels in the blood. For most patients, the surgery is curative, leading to significant improvement in symptoms, calcium levels, and long-term health.
While the benefits of this surgery are well established, it is still an invasive procedure. Like all surgeries, parathyroidectomy carries certain risks and potential complications that patients should be aware of before undergoing treatment. These risks may vary depending on factors such as the patient’s overall health, the extent of the surgery, and the skill of the operating surgeon, including the specific risks and complications of parathyroidectomy surgery.
Overview of the Procedure
Risks and Complications of Parathyroidectomy Surgery involves removing one or more of the parathyroid glands, which are located behind the thyroid gland in the neck. Most cases involve the removal of a single overactive gland due to a benign tumor (adenoma). In other cases, multiple glands may need to be removed, especially in genetic syndromes or kidney-related hyperparathyroidism. It is essential to understand the risks and complications of parathyroidectomy surgery before proceeding, including the risks and complications of parathyroidectomy surgery.
Surgery is usually performed under general anesthesia and can be minimally invasive or open, depending on the diagnosis, imaging findings, and surgeon’s recommendation. The majority of patients are discharged the same day or after a short hospital stay, and recovery is typically smooth.
Risks and Complications of Parathyroidectomy Surgery
Hoarseness or Voice Changes
One of the most commonly discussed risks after parathyroid surgery is a change in the voice. This is due to the proximity of the recurrent laryngeal nerve, which runs very close to the parathyroid glands and controls the vocal cords.
In most cases, any voice change is temporary and improves within a few weeks. However, if the nerve is stretched, bruised, or accidentally damaged during surgery, it may lead to long-term hoarseness, a weaker voice, or difficulty projecting. Permanent injury to this nerve is rare, occurring in less than 1% of cases when performed by experienced surgeons.
Low Calcium Levels (Hypocalcemia)
Another common issue that may arise post-surgery is hypocalcemia, or low blood calcium levels. This happens when the body suddenly has reduced levels of parathyroid hormone, especially if multiple glands were removed or if the remaining glands are temporarily “stunned” after surgery.
Patients may experience tingling in the fingers, lips, or around the mouth, muscle cramps, or in severe cases, seizures. Typically, this is a temporary condition and can be managed effectively with calcium and vitamin D supplementation. Blood calcium levels are closely monitored after surgery to prevent complications.
In rare cases, permanent hypoparathyroidism may occur if all functioning glands are removed or damaged, requiring lifelong calcium and vitamin D replacement therapy.
Neck Pain or Stiffness
As with most surgeries involving an incision, some mild neck pain, swelling, or stiffness is common in the first few days following parathyroidectomy. This discomfort is generally short-lived and managed with over-the-counter pain relievers. Applying cold compresses and gently stretching the neck can also help with recovery.
In patients undergoing a more extensive surgery, such as bilateral exploration or total parathyroidectomy, soreness may last a bit longer. However, severe or worsening pain should always be reported to the healthcare provider, as it could indicate infection or bleeding.
Bleeding and Hematoma
Though rare, bleeding after parathyroid surgery can lead to the formation of a hematoma—a localized collection of blood under the skin. This may cause swelling, bruising, or tightness in the neck. In severe cases, it can compromise the airway and require urgent medical attention.
To minimize this risk, patients are usually advised to stop taking blood thinners, such as aspirin or certain supplements, before the procedure. Hematoma is estimated to occur in less than 1% of cases and is more likely in patients with underlying clotting disorders.
Infection
Infection is uncommon following parathyroidectomy because the incision is small and the surgical field is usually clean. However, if an infection does occur, it may result in redness, warmth, swelling, discharge from the incision site, or fever.
Treatment typically involves a short course of antibiotics and wound care. Serious infections requiring hospitalization or further intervention are rare.
Scarring and Cosmetic Concerns
Parathyroidectomy involves a small incision on the front of the neck, which usually heals very well and leaves minimal scarring. In most patients, the scar fades significantly over time and becomes barely noticeable. However, in rare instances, individuals may develop keloids or hypertrophic scars—thickened or raised scars that can be itchy or cosmetically bothersome.
Patients concerned about the appearance of the scar can discuss minimally invasive techniques or hidden-incision approaches, where the cut is made in a natural crease of the neck. Silicone gels and scar treatments may also be recommended after healing.
Injury to Surrounding Structures
The neck is a delicate area with important nerves, blood vessels, and organs. While uncommon, accidental injury to surrounding structures—such as the esophagus, trachea, or large neck vessels—can occur during parathyroid surgery, particularly if the anatomy is abnormal or previous surgeries have caused scarring.
These complications are rare when the procedure is performed by an experienced endocrine surgeon, but patients with complex conditions should be aware of these risks.
Persistent or Recurrent Hyperparathyroidism
In some cases, patients may continue to experience elevated calcium or parathyroid hormone levels after surgery. This can happen if the overactive gland was not completely removed or if supernumerary parathyroid glands (extra glands) were missed during the procedure.
Recurrent hyperparathyroidism may also develop years later due to new adenomas or hyperplasia. Repeat imaging and possibly revision surgery may be required in such cases.
Long-Term Outlook and Risk Reduction
Despite these potential complications, parathyroidectomy remains a highly successful procedure with a cure rate of over 95% for primary hyperparathyroidism when performed by experienced surgeons. Most complications are either rare or manageable with early intervention.
Patients can reduce the risk of complications by:
- Choosing a qualified endocrine or head-and-neck surgeon
- Following all preoperative instructions
- Reporting any symptoms early during recovery
- Attending follow-up appointments for lab monitoring
Being informed about possible complications allows patients to recognize early warning signs and seek help promptly, reducing the risk of long-term problems.
Conclusion
Parathyroidectomy is a safe and effective treatment for most cases of hyperparathyroidism, particularly when performed by experienced hands. While the surgery has a high success rate, it’s important to understand the potential risks and complications, ranging from minor side effects like neck soreness to rare issues like nerve injury or persistent hormone imbalance.
Knowing what to expect before and after surgery can empower patients to take an active role in their care, ask the right questions, and ensure the smoothest recovery possible. If you are considering parathyroid surgery, discussing all concerns and expectations with your surgeon can help you prepare for a successful outcome.
