Our Summary

This research paper examined the outcomes of two types of surgeries: parathyroidectomy (PTx), which is a surgery to remove the parathyroid glands, and concurrent parathyroidectomy and thyroidectomy (PTx + Tx), which is a surgery to remove both the parathyroid and thyroid glands. Data was collected from over 10,000 patients who had these surgeries between 2014 and 2019.

The findings showed that patients who had the combined surgery were more likely to experience hypoparathyroidism, a condition where the body produces less parathyroid hormone, nerve transection (cutting of the laryngeal nerve), and hematoma (swelling of clotted blood) that required evacuation. These patients were also more likely to be readmitted to the hospital and visit emergency departments due to low calcium levels in their blood (hypocalcemia). The combined surgery was associated with an 8-fold increase in risk of short-term complications.

In simpler terms, the study found that patients who had both the parathyroid and thyroid glands removed at the same time were more likely to have complications and hospital visits after the surgery compared to those who only had the parathyroid glands removed. These findings can be used to inform discussions between surgeons and patients about the risks of having both surgeries at the same time.

FAQs

  1. What are the potential risks and complications of concurrent parathyroidectomy and thyroidectomy compared to parathyroidectomy alone?
  2. Is there an increased risk of readmissions and emergency department visits following concurrent parathyroidectomy and thyroidectomy?
  3. What is the risk increase of short-term complications following concurrent parathyroidectomy and thyroidectomy surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to carefully consider the risks and benefits of concurrent parathyroidectomy and thyroidectomy (PTx + Tx) versus parathyroidectomy alone. This study suggests that patients undergoing PTx + Tx have increased rates of postoperative complications, ED visits, and readmissions compared to patients undergoing parathyroidectomy alone. It is important to have a thorough discussion with your surgeon about the potential risks and benefits of each approach before making a decision.

Suitable For

Patients who are recommended parathyroidectomy typically have primary hyperparathyroidism, secondary hyperparathyroidism, or tertiary hyperparathyroidism. These patients may have symptoms such as high levels of calcium in the blood, kidney stones, bone pain, fatigue, and frequent urination. They may also have complications such as osteoporosis, kidney damage, and cardiovascular issues related to their hyperparathyroidism. It is important for these patients to undergo parathyroidectomy to remove the overactive parathyroid gland and correct the underlying condition.

Timeline

Before parathyroidectomy:

  • Patient may experience symptoms of hyperparathyroidism, such as fatigue, weakness, bone pain, and kidney stones
  • Patient undergoes preoperative evaluation, including blood tests and imaging studies to confirm the diagnosis and determine the location of the abnormal parathyroid gland
  • Patient discusses the risks and benefits of surgery with their healthcare provider
  • Surgery date is scheduled and patient prepares for the procedure by fasting and following any preoperative instructions

After parathyroidectomy:

  • Patient undergoes the surgical procedure to remove the abnormal parathyroid gland
  • Patient is monitored in the recovery room for any immediate complications
  • Patient may experience temporary hoarseness or difficulty swallowing due to the proximity of the surgery to the vocal cords and esophagus
  • Patient is discharged home with instructions for postoperative care, including pain management and monitoring for signs of complications
  • Patient follows up with their healthcare provider for postoperative visits to monitor calcium levels and ensure proper healing

Overall, the patient may experience relief from symptoms of hyperparathyroidism and improved overall health following successful parathyroidectomy.

What to Ask Your Doctor

  1. What are the potential short-term and long-term complications associated with parathyroidectomy, especially if combined with thyroidectomy?
  2. How common is clinical hypoparathyroidism after parathyroidectomy, and how is it typically managed?
  3. What is the risk of recurrent laryngeal nerve transection during surgery, and what are the potential consequences?
  4. How likely is it to experience a hematoma requiring evacuation after parathyroidectomy, and how is it typically treated?
  5. What is the likelihood of needing readmissions or emergency department visits for hypocalcemia following parathyroidectomy with or without thyroidectomy?
  6. How does the risk of postoperative complications differ between parathyroidectomy alone and parathyroidectomy combined with thyroidectomy?
  7. What factors should be considered when deciding between a standalone parathyroidectomy and a combined procedure with thyroidectomy?
  8. How experienced are you with performing parathyroidectomy with or without thyroidectomy, and what is your complication rate for these procedures?
  9. Are there any alternative treatment options to consider besides parathyroidectomy or parathyroidectomy with thyroidectomy?
  10. Can you provide me with more information about your surgical approach and techniques for parathyroidectomy to help me better understand the procedure and potential risks?

Reference

Authors: Pradhan MC, Young CD, Thomas SM, Stang MT, Kazaure HS, Scheri RP. Journal: Am J Surg. 2022 Nov;224(5):1190-1196. doi: 10.1016/j.amjsurg.2022.03.041. Epub 2022 Mar 26. PMID: 35365294