Can Parathyroidectomy Cause Chest Pain After Surgery?
Yes, postoperative chest pain after parathyroidectomy occurs in approximately 4.7% of patients, but it rarely indicates a true cardiac event and typically does not require extensive cardiac workup in low-risk patients. 1
Incidence and Clinical Significance
- Chest pain is reported in the immediate postoperative period in about 1 in 20 patients undergoing parathyroidectomy for primary hyperparathyroidism 1
- Despite chest pain prompting cardiac investigations (typically 12-lead ECG and troponin) in most cases, none of these patients were diagnosed with an actual cardiac event 1
- The risk of significant postoperative cardiac complications after parathyroidectomy is minimal 1
Risk Factor Analysis
When comparing patients who developed chest pain versus those who did not, there were no significant differences in the following factors 1:
- Age
- Gender
- Body mass index
- Presence of cardiovascular risk factors
- American Society of Anesthesiologists (ASA) score
- Length of surgery
Clinical Approach to Postoperative Chest Pain
Evaluate each patient's pretest probability of cardiac events rather than reflexively ordering extensive cardiac workups 1
- In low-risk patients without significant cardiovascular risk factors, extensive cardiac investigation is likely unnecessary and represents low-value care 1
- Most postoperative chest pain after parathyroidectomy is non-cardiac in origin, despite its occurrence in the immediate postoperative period 1
Alternative Causes to Consider
While the evidence focuses on cardiac causes, postoperative chest pain may also relate to:
- Hypocalcemia: A common complication after parathyroidectomy that can cause neuromuscular symptoms including chest wall muscle spasms 2, 3
- Surgical positioning or musculoskeletal strain during the procedure
- Postoperative anxiety or hyperventilation
Important Caveat
Do not completely dismiss chest pain, but rather use clinical judgment to determine the appropriate level of investigation based on individual patient risk factors and the clinical presentation 1. The key message is avoiding reflexive, extensive cardiac workups in patients with low pretest probability of cardiac disease.