Surgeons should always try to preserve the parathyroid glands during thyroid surgery. Sometimes, it is not possible to save all four parathyroid glands, as a parathyroid gland can be attached to or within the thyroid gland itself. This is ok, though, since you really only need one parathyroid gland. One gland can make enough parathyroid hormone (PTH) to regulate your calcium levels.

If one, two, or even three parathyroid glands were injured or removed during your thyroid operation, you might not even notice - as long as you had one good gland remaining, you would be fine.

If all four parathyroid glands were injured or removed, you would know it! This is called hypOparathyroidism, when you don’t have enough parathyroid tissue to regulate your calcium levels. Your calcium level would drop into the low range soon after surgery, and you would probably have pretty significant symptoms - numbness and tingling in hands and face, then buzzing or jitteriness throughout your body, cramping in your hands with muscle contractions in the hand and wrist. You would have to take large amounts of Vitamin D and calcium in order to maintain your calcium levels in the low-normal range. And your PTH level would remain low, even when your calcium dropped into the low range (normal parathyroid glands will respond to low calcium by making more PTH, giving you a high PTH level).

It is easy to know whether you have a working parathyroid gland - check your calcium and PTH levels. If your calcium level is in the normal range (mid to high 9s) and your PTH is also normal, then you have a working parathyroid. If your calcium is on the low end and your PTH is on the higher end, that is a normal response and indicates that you have a working parathyroid.

If your calcium level is chronically low (low 9s or below) and your PTH remains low (often under 20 pg/ml, and close to 0 if you had all four parathyroid glands removed) then you have hypoparathyroidism. The first treatment is aggressive calcium and Vitamin D supplementation.