From the Guidelines
Parathyroidectomy patients should be followed up with a standardized protocol that includes consultation with a surgeon, procedure details, post-operative follow-up with the surgeon, and subsequent follow-up with an endocrinologist for laboratory tests, with a focus on monitoring calcium levels and adjusting supplements as necessary to prevent hypocalcemia and other complications, as recommended by the most recent guidelines 1. The follow-up protocol typically begins with a surgical consultation to discuss the procedure, risks, benefits, and alternatives. During this visit, the surgeon will review lab results, imaging studies, and medical history to confirm the need for surgery.
- The procedure itself involves removing one or more parathyroid glands through a small incision in the neck, typically taking 1-2 hours under general anesthesia.
- Patients usually stay in the hospital for 24 hours for monitoring of calcium levels, with blood levels of ionized calcium measured every 4 to 6 hours for the first 48 to 72 hours after surgery, and then twice daily until stable 1.
- After discharge, patients should take calcium supplements, such as calcium carbonate 1 to 2 g 3 times a day, and calcitriol of up to 2g/day, as directed by the surgeon or endocrinologist, to maintain normal calcium levels 1.
- The first post-operative visit with the surgeon occurs 1-2 weeks after surgery to check the incision and review pathology results.
- Blood tests to monitor calcium and parathyroid hormone (PTH) levels are essential during this period, with follow-up with an endocrinologist scheduled 2-4 weeks post-surgery, then at 3 months, 6 months, and annually thereafter 1.
- The endocrinologist will monitor calcium, PTH, vitamin D levels, and bone health, adjusting supplements as needed to prevent hypocalcemia and other complications, such as muscle cramps and tingling, which can occur in patients with temporary or permanent hypoparathyroidism after surgery 1.
From the Research
Pre-Operative Protocol
- Consultation with a surgeon is necessary to discuss the details of the parathyroidectomy procedure 2, 3
- Preoperative laboratory tests, including parathyroid hormone (PTH) and calcium levels, are typically conducted to assess the patient's condition 2, 4
- Vitamin D levels are also evaluated, as they can impact the risk of postoperative hypocalcemia 2, 5
Procedure Details
- The surgical approach may vary, with options including subtotal parathyroidectomy, total parathyroidectomy without auto-transplantation, or total parathyroidectomy with auto-transplantation 3, 4
- A skilled surgeon with extensive experience in parathyroid gland surgery is essential for a successful outcome 3
Post-Operative Follow-Up with the Surgeon
- Patients are typically monitored for postoperative hypocalcemia, which can occur in up to 23% of cases 2
- Serum calcium and PTH levels are closely monitored, and patients may require intravenous calcium supplements or active vitamin D metabolites to manage hypocalcemia 5
- Daily follow-up of serum calcium and phosphorus levels is necessary to prevent post-operative complications 5
Subsequent Follow-Up with an Endocrinologist (Endo)
- Long-term follow-up with an endocrinologist is necessary to monitor the patient's condition and adjust treatment as needed 6
- Laboratory tests, including serum calcium, PTH, and vitamin D levels, are conducted to assess the patient's response to treatment and detect any potential complications 6
- Patients may require ongoing management of their calcium and vitamin D levels to prevent hypocalcemia and other complications 6, 5