The risk of complications is thought to be directly related to the yearly operating volume of the surgeon. A yearly volume of a least 20 parathyroid surgerycases a year should be adequate to maintain the surgeons skills. In the 2007 BAETS Audit Report only 17 surgeons in the UK performed this yearly volume (30%), while 43% undertook less than 10 parathyroidectomies a year and 21% five or less cases. These figures are quite concerning because the audit was of surgeons with a claimed special interest in thyroid and parathyroid surgery. As such a large numberof surgeons, who are even members of the BAETS, do such a low volume of parathyroid surgery, patients would be well advised to question their surgeon about his or her yearly volume.
Failure to cure - In expert hands there should bea failure rate of less than 5% in first explorations. In second or subsequent explorations with sophisticated imaging and expert hands it does not rise above this level. Patients with hyperplasia who opt for less than total parathyroidectomy must be warned of the risk of recurrence years after initial surgery. In patients whose surgery has failed it is essential to confirm that the original diagnosis is the correct one and to repeat all the imaging.
Low serum calcium - Th is is very common in the first few days after surgery. It presents as a tingling around the mouth and in the limbs.The calcium may not return to normal for 36hrs. If a single parathyroid adenoma has been removed and the parathyroid disease is mild and the bones not affected the calcium settles in a day or so. Sometimes added calcium is necessary for a few days. If the bones have been affected, supplementary calcium and vitamin D is given until the bones heal. In some cases vast amounts of calcium and vitamin D must be given to maintain normal serum calcium as calcium pours back into the bones from the blood (hungry bone syndrome).
On occasions it is necessary for a continous infusion of calcium to be given intravenously. It is mandatory that such an infusion is given through a central venous line and not through a limb vein because extravasation may result in local tissue necrosis.When large amounts of calcium with vitamin D are being ingested the serum calcium must be checked weekly, because once the bones have healed the calcium will soar to dangerous levels if the supplements are not stopped. In patients with parathyroid hyperplasia the need for supplements depends not only on the presence of bone disease, but also on the amount of parathyroid tissue removed.
Change in voice - The risk of voice change is very small (well below 1%) but is said to be higher in patients who have had previous neck surgery. One must not be complacent however: A recentmedicolega lreferral patient had undergone two operations; the first failed to find the tumour and unfortunately one recurrent laryngeal nerve was damaged. At a subsequentsecond operation the parathyroid adenoma was found,but the remaining nerve wasalso damaged,this resulted in severe breathing problems and the need for a permanent tracheostomy with a very weak voice.
Wound problems are rare - Small collections of blood or serum may occur under the wound and at worst need little else than needle aspiration without anaesthetic. Return to theatre for serious bleeding problems in our hands is excessively rare (less than 1 in 750cases). Some patients produce very thick scars (hypertrophic or keloid scars); this is common in black skinned and fair redheaded patients. In patients with generalized eczema, a new area of eczema may develop along the scar.