Parathyroidectomy

<Surgical Mx>

<Index>

 

Definition

-  Surgical removal of parathyroid gland

 

Features

-   

 

Indications

-  Primary hyperparathyroidism

-  Adenoma 90%

-  Diffuse hyperplaseia

-  Carcinoma (rare)

-  Secondary hyperparathyroidism in CRF

 

Procedure

-  Pre-op

-  FBE, U&E, TFT, CMP, PTH, G&H, INR, APTT, Vitamin D

-  CT, MRI, US &/or nuclear imaging

-  24hr urinary calcium excretion: to eclude familial hypocalciuric hypercalcaemia

-  Vocal cord assessment

 

Complications

-  Hypocalcaemia

-  Hypoparathyroidism

-  Vocal cord paralysis

-  Transient 3%

-  Permanent 1%

-  Hungry bone syndrome

 

Post Surgery Mx

-  No anticoagulants

-  Calcium

-  All pts Caltrate 1200mg PO BD

-  F/U

-  1 & 6/52 post op w Surgeon

-  4/52 w Endocrinologist

-  LMO for calcium monitoring

 

Calcium

-  Watch for Hypocalcaemia post op

-  All pts commence Caltrate 1200mg PO BD immediately post op

-  iPTH measured 1/24 post op

-  iPTH <1.6pmol/L

-   iPTH 0.6-1.6pmol/L: BD CMP for serum Calcium (Ca)

-   If Day 2 Ca >2.00mmol/L = safe for D/C

-   If Day 2 Ca <2.00mmol/L = Calcitriol 0.5ug PO BD + Caltrate 1200mg TDS

-   iPTH <0.6

-   BD CMP for Ca

-   Calcitriol 0.5ug PO BD

-   + Caltrate 1200mg PO TDS

-   If Day 2 Ca >2.00mmol/L = safe for D/C

-  iPTH >1.6pmol/L

-   CMP for Ca next morning >2.00mmol/L = safe for D/C

-  CMP for Ca measured morning after surgery

-  If Ca continues to drop give Calcium Gluconate &/or further oral supplements

-  On D/C

-  If just on Caltrate 1200mg BD

-   1/52: if Ca >2.00mmol/L --> Caltrate 600mg BD

-   2/52: if Ca >2.00mmol/L --> Caltrate 600mg Daily

-   3/52: if Ca normal range --> cease Caltrate

-  If on Caltrate x2 TDS & Calcitriol 0.5ug BD

-   1/52: if Ca >2.00mmol/L --> Caltrate 1200mg BD + Calcitriol 0.25ug BD

-   2/52: if Ca >2.00mmol/L --> Caltrate 600mg BD + Calcitriol 0.5ug Daily

-   3/52: if Ca >2.00mmol/L --> Caltrate 600mg Daily & cease Calcitriol

-   4/52: if Ca normal range --> cease Caltrate

 

Wound Care

-  Drain tube 24-48hrs

-  Dressings intact & dry 7/7

-  Haemorrage into tissues can be life threatening --> resp arrest

-  Early signs of repiratory obstruction

-   Restlessness, apprehension

-   Sweating, breathlessness

-   Tachycardia, HTN

-   Neck swelling

-   Increased neck drain output

-  Late signs of repiratory obstruction

-   Cyanosis

-   Stridor

-   Decreased conscious state (GCS)

-  Remove dressing from wound, cut sutures

-  If above ineffective consider tracheostomy

-   DO NOT attempt ETT intubation --> may cause total obstruction