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Postop expectations

Most patients can expect an improvement in health after parathyroid surgery, but the road back to health is not always smooth. It helps to know what to expect.

Is surgery going to help my symptoms? I am exhausted, and just don't feel like myself any more. I have had high calcium levels for the last four years. My doctor recently diagnosed primary hyperparathyroidism but said that I don't need surgery. He doesn't have an explanation for why I feel so bad. My doctor does not think these symptoms are related to the parathyroid, or that parathyroid surgery will help.

Fatigue is the most common symptom reported in patients with primary hyperparathyroidism. It is very likely that your parathyroid condition is a major cause of why you are feeling exhausted. It is also common for patients to state that "I'm no myself any more." Fortunately, these symptoms improve once the parathyroid disease is treated (once the diseased parathyroid gland is removed). Based on ...

Symptoms Operation Postop expectations

When can I expect to feel better after surgery? I’ve been feeling terrible.

This is a great question. Unfortunately there isn’t a single answer for everyone. On average, most people will feel better within a few weeks after surgery, and this improvement can continue for months. But that is just the average. I have had patients who wake up after surgery and felt like a cloud was lifted. They feel amazing, right after the operation. These patients are rare, but they happ...

Outcomes Primary HPT Operation Postop expectations FAQ

How is parathyroid hyperplasia different from a parathyroid tumor? I had a parathyroid operation for primary hyperparathyroidism and was told that I had hyperplasia. Am I going to have the same benefit from surgery as someone with a tumor?

Parathyroid hyperplasia is a form of hyperparathyroidism in which all four glands are overactive. In the most common form of primary hyperparathyroidism, a patient will have one or two parathyroid adenomas, benign tumors that grow from the parathyroid glands. But some patients have hyperplasia, which is not caused by parathyroid tumors. It is simply an enlargement and overactivity of all of the...

Hyperplasia Outcomes Postop expectations

Three years ago I had a parathyroid tumor removed. I did very well, but recently my PTH has gone up to 85 pg/ml (normal range up to 65 pg/ml). Do I have another parathyroid tumor? My last calcium was 9.1 mg/dl.

Your labs are now more consistent with secondary hyperparathyroidism (not primary hyperparathyroidism, which is what you had three years ago). That is, the parathyroid glands are making more hormone in response to a low calcium level. Ideally you want your calcium level to be closer to the mid to high 9s in mg/dl. Your remaining parathyroid glands are doing exactly what we want them to do when ...

Postop expectations Diagnosis Secondary HPT

I had parathyroid surgery last week, and I'm feeling worse than I did before the operation. I'm exhausted and feel weak. What is wrong with me? My calcium is normal but it seems like the operation did not help.

I'm sorry that you are having such a tough time. Fortunately, you are most likely cured and what you are going through is normal, and will improve in the next few weeks. It is actually not that uncommon to feel worse in the first week or two after surgery, as your body adjusts to the new hormone and calcium levels. Think about it: your body had years to adjust to having parathyroid disease, wit...

Postop expectations

Will I need to take medications after parathyroid surgery?

After surgery, you will need two things, which are over-the-counter: 1. Calcium and Vitamin D 2. Pain control Most patients will not need any prescription medications after surgery. I generally recommend over-the-counter medications for pain control, such as ibuprofen (Motrin, Advil) and acetaminophen (Tylenol). Narcotics have side effects and are usually not more effective than the over-...

Postop expectations Vitamin D

I had parathyroid surgery three days ago. I felt great until yesterday, when I started noticing tingling in my hands. Today I feel weak and jittery, like I'm buzzing all over. I have been taking calcium. What is going on?

This sounds like you are experiencing symptoms of low calcium. After surgery, the PTH drops quickly, and then the calcium drops over the next few days. If symptoms of low calcium are going to occur, they usually occur 2 to 3 days after surgery. The first symptom is usually numbness or tingling in the fingertips or around the mouth. The tingling can then spread up your arms. Eventually you may f...

Postop expectations

I had a parathyroid tumor removed three weeks ago. I feel fine, but my surgical site is concerning me. At the incision site, the skin is red and bumpy, and feels hard. There isn't much swelling, and it doesn't hurt, but it really doesn't look good. What can I do?

When my patients report this to me, the first thing I do is ask them to send me a photo. This is the best way for me to assess it (other than seeing it in person). Before I would make any conclusions about your incision, I would want to see a picture. Having said that, though, what you are describing sounds normal. In the weeks after surgery, the incision tends to look red (at the incisio...

Postop expectations

I had parathyroid surgery one week ago. My fatigue has improved, but I've been getting daily cramps in my legs. Is this low calcium? What should I do?

Cramps can be a symptom of low calcium, especially if you are also feeling the more classic symptoms of low calcium such as numbness or tingling in yours hands or face. If the numbness and tingling is also present, then taking extra calcium will likely help with the cramps as well. For anyone with postop cramps, I recommend taking magnesium supplements in addition to calcium and Vitamin D....

Postop expectations

I had parathyroid surgery last year. I am still on calcium and Vitamin D supplements but wondering if I can stop. My calcium has been normal. When can I stop the calcium?

I usually determine when calcium can be stopped based on two things: 1. Your serum calcium level. If it is low (under 9.3 mg/dl), then I usually recommend continuing to take calcium. If it is truly in the normal range, then it may be possible to stop. 2. Your bone health. If you have osteopenia or osteoporosis, I usually recommend staying on calcium and Vitamin D for the sake of your bones....

Postop expectations

I had parathyroid surgery four days ago. I had some tingling yesterday and took extra calcium, and that has resolved. My issue is that I'm having loose stools and abdominal cramping. Do you know what is causing this?

This may be a gastrointestinal reaction to the calcium you are taking. Calcium citrate is a form of calcium I frequently recommend because it tends to not cause constipation as much as some other forms. But it can cause the opposite problem of loose stools. If you are taking calcium citrate, you may want to try a different form of calcium. The most common form of calcium supplement is calcium c...

Postop expectations Postop complications

Is a parathyroid surgery out-patient? What is the recovery time? What are the risks?

Thanks for asking! Parathyroid surgery is nearly always outpatient, and you go home the same day as the operation. There are some rare exceptions, so occasionally someone will need to spend the night in the hospital. For example, patients who are on dialysis for kidney failure or patients with very severe heart or lung disease that might need to be monitored for a little longer after surger...

Operation Postop expectations Popular Postop complications

Is it common for PTH levels to fluctuate after removal of 1 parathyroid gland? I had surgery and a week later, my PTH was at 96.7. Calcium and Vit D were closer to normal.

The simple answer is yes, it is common (and even expected) for PTH levels to fluctuate after surgery. Right after a parathyroid tumor is removed, PTH levels plummet. If the other parathyroid glands are normal, then they are dormant, and making very little PTH. A day after surgery, I expect the PTH level to be low. Calcium levels drop soon after that as a result of the drop in PTH. In the we...

Operation Postop expectations

How soon after surgery are calcium and vitamin D levels checked? Who follows the patient after surgery to check calcium/vit-D levels (primary care doctor, endocrinologist, Dr. Boone), and how often and how long should a patient be followed after surgery to check these two levels? Thank you.

I like to check the calcium, PTH, and Vitamin D around four to six weeks after surgery. Immediately after surgery, your PTH level will drop. Then over the next few days your calcium will drop as well. In the couple of weeks after the operation, your levels will be fluctuating. I don't check them routinely at this point, since the fluctuating levels may not give a very accurate picture. Afte...

Postop expectations

After surgery is done, how many days off do you need to recuperate before one can go back to work?

This can vary a lot. In general, I tell patients to take off a week from work if they can. If they cannot or do not want to take off a week, then I say to at least take a couple of days off. Most people can get back to regular activities within a few days. But you do not always know how your body is going to react, so I recommend taking the week off just in case it takes you a little longer...

Postop expectations Operation

I am 6 weeks past parathyroid surgery. Prior blood tests showed 12.3 calcium, 425 PTH. One large tumor was removed and the other 3 parathyroids were checked as normal and left in situ. PTH one hour after surgery was 33. Blood test today is 9.3 calcium and 131 PTH. Is it normal for the PTH to fluctuate for awhile? Or, do I need additional calcium or Vitamin D? I am taking 650mg calcium and 25mcg of Vit D daily since surgery.

Yes, it is common for PTH levels to fluctuate after parathyroid surgery, especially when the calcium drops down into the low-normal range after being elevated for so long. Your calcium level is now in the low-normal range, which is a good sign. The PTH is high, but this is may be appropriate for your calcium. Your body was dealing with parathyroid disease for years, and you had a pretty hi...

Operation Postop expectations