Removing the parathyroid glands

If your parathyroid glands grow and make too much PTH, your doctor may want you to have them taken out (parathyroidectomy). This is most often done with general anesthesia.

Most people have four glands in the front of the neck, but they can be hard to find. They may hide in your chest, or you may have more than four. A first parathyroid surgery is usually safe. Having to go back in a second time has a higher risk of surgical problems. Ask your surgeon about:

• Having an ultrasound before surgery to find the glands.
• Testing your PTH just before and 10 minutes after taking out the glands to be sure it has dropped enough and no glands were missed.

In some cases, the surgeon may place one of the parathyroid glands that were removed into the tissue of your forearm. This way, you can still make some PTH. And, if that gland gets too big, it is easy to find and remove. If all of your glands are removed and you make no PTH, you may be able to take PTH injections instead.

After the surgery, you may be in the intensive care unit for a few days to keep a close eye on your calcium. When high levels of PTH in your blood fall quickly, "hungry bone syndrome" can occur—your bones try to steal calcium from your blood. You'll get to eat as much dairy food as you like in the hospital to keep your blood levels up. You will likely get calcium through an IV. Signs of not having enough calcium in your blood include:

• Muscle aches, tremors, or painful cramps
• Muscle spasms of the face
• A tingly or "pins and needles" feeling in your lips, tongue, fingers, or toes

If you have any of these symptoms after surgery, tell the nurse or doctor right away so they can check your blood again.

To keep your bones as healthy as possible:

• Make a plan with your care team to reach your lab value goals.
• Know your lab values and track them each month.
• Follow the diet for your type of dialysis.
• Take all your drugs as your doctor prescribes them.