What does the initial visit consist of?
Your initial visit with Dr. Joshi will involve a consultation during which time, all of your lab results, radiology reports, and scans will be reviewed. Dr. Joshi will usually perform an ultrasound of the neck to confirm the position of your parathyroid adenoma.

You should expect the initial visit to last approximately 40 to 45 min.

How long does the surgery take to perform? A typical parathyroidectomy takes 30 minutes for a localized parathyroid adenoma. The case might take longer, if the intraoperative parathyroid hormone levels do not decrease as expected and the other parathyroid glands need to be explored.

What is the Intraoperative Parathyroid Hormone (IOPTH) assay and how is it useful? IOPTH is a biochemical blood test to make sure that the correct hyperfunctioning gland, which is the cause of your elevated parathyroid hormone, has been surgically removed. If the correct parathyroid adenoma has been removed, then the PTH levels should drop appropriately.

We can check this level in the operating room, to make sure that the parathyroid gland we have removed is the actual one that is causing the problem. IOPTH is not always necessary to perform a successful parathyroidectomy, but the recurrence rates are slightly higher without use of the IOPTH assay. With the proper use of this technology, the chances for a successful and outcome are maximized.

What is the recovery time like? Typically patients are back to normal and feeling well after 1-2 days.

Will I need to stay overnight in the hospital? There is usually an overnight stay required for parathyroidectomy. I like to monitor patients’ calcium levels every 6 hours after the surgery to make sure that the calcium levels do not drop to dangerous levels. This can happen sometimes, especially if you are Vitamin D deficient. Patients can then go home the first thing in the morning.

Why would my calcium levels drop after the surgery? Shouldn’t they be normal if the parathyroid hormone level comes back down to normal?Good question. If you had a parathyroid adenoma and elevated parathyroid hormone levels for a long period of time and didn’t know it, then your bones maybe depleted of their calcium deposits. After the parathyroid adenoma is removed, your blood calcium levels fall to normal. But now, your bones are “hungry” for calcium and take up as much calcium as possible from the blood.

This “hungry bone syndrome” causes hypocalcemia or low calcium levels in the blood, until the bones re-accumulate their calcium stores. When this happens the blood calcium levels normalize. This may take weeks, depending on how long you have had elevated parathyroid hormone levels.

Any dietary restrictions after the surgery? None. You may eat and drink normally after your surgery.

Can I speak after surgery? You may use your voice immediately after the surgery.

Will I be sent home with any medications? You will be given pain medications and antibiotics. Additionally, if your calcium levels are low after the surgery, then you will be sent home on calcium supplementation for a shot period of time.

What types of activities can I perform after surgery? I would not recommend heavy lifting or straining immediately after surgery. You can resume heavy lifting and straining 1 week after surgery.

When do I come in for my follow-up visit? You should be seen 1-2 weeks following surgery.

Will my stitches need to be removed? All the stitches will be dissolvable, and we do not need to remove any of them.

What are the risks of parathyroid surgery? Aside from possible bleeding and infection, the major risks to parathyroidectomy are injury to the recurrent (causing hoarseness), hypocalcemia (low calcium levels), and poor scarring. In a competent surgeon’s hands, these risks are in the single digits.

There are several practitioners in my area who perform parathyroid surgery. How should I choose one? Are there questions I should ask during the consultation?

There are a few things to consider when deciding on a surgeon.

Ask how many parathyroid surgeries the surgeon has done during the past three months to get a sense of his/her experience. Parathyroid surgery is technically challenging. Make sure that you choose someone who has the requisite technical skills to treat the challenging cases.

Ask if your surgeon is fellowship trained in parathyroid surgery. Bear in mind that fellowship training in parathyroid surgery is relatively new. For those surgeons who have been in practice for over 5 years, this would not have been available to them. There are many competent surgeons who have not had fellowship training. Nevertheless, this is something that allows you as a patient to understand how up-to-date your parathyroid surgeon is with new techniques.

Ask if your surgeon has the Intra-Operative Parathyroid Hormone Assay available. IOPTH is not always necessary to perform a successful parathyroidectomy, but the recurrence rates are slightly higher without use of the IOPTH assay. With the proper use of this technology, the chances for a successful and outcome are maximized.

Ask if your surgeon uses laryngeal nerve monitoring. Successful parathyroidectomy does not always require the use of laryngeal nerve monitoring, but there has been a positive trend towards the use of monitoring during parathyroidectomy. If you are undergoing parathyroidectomy, you should have the state of the art technology available in order to minimize the chance of an injury to your voice.

In the end, the decision to choose a surgeon is a very personal one. Don’t be rushed through the pre-operative consultation. Make sure that you can trust what your surgeon has to say, make sure that you have adequate time to get an answer to all of your questions, and make sure that you have been able to establish a rapport with the surgeon.