patient information leaflet p2 - baets · patient information leaflet p2 potential consequences of...
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PatientInformationLeafletP2
POTENTIALCONSEQUENCESOFPARATHYROIDSURGERY
Parathyroidsurgeryisgenerallyasafeprocedure.Thevastmajorityofpatients
undergoinganoperationontheparathyroidglandhavenocomplications.
However,aswithanysurgicalprocedure,therearesomerisksassociatedwith
theoperationandtheseshouldbefullyexplainedtoyoubyyoursurgicalteam.
RecurrentLaryngealnerve‘Voicenerve’
Thyroidgland
Parathyroidglands
Clavicle‘Collarbone’
Sternum‘Breastbone’
SuperiorLaryngealnerve
Larynx’Adam’sapple’
Voicechanges
Therearethreepossiblereasonsforsuchchangestooccur:
Injurytotherecurrentlaryngealnerve(s)
Therearetworecurrentlaryngealnerves,oneoneachsideoftheneck.They
passbehindthethyroidglandandintothelarynx(voicebox)wheretheycontrol
movementsofthevocalcords.
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If“bruised”,thenervedoesnotworkproperlyimmediatelyaftersurgerybut
recoversandshouldreturntonormalfunctionduringthenextfewdaysor
weeks.Sometimes,however,itcantakeuptoafewmonthsforthevoiceto
returntonormal.
Permanentdamagetooneofthesenerves(risk:approximately1in100)causes
ahoarse,croakyandweakvoice.Thebodyusuallyadaptstothedamageand
symptomsmaygetbetterwithtime.Ifvoiceproblemspersistformorethan
threemonthsyouwillbereferredforvoicetherapy.Sometimesfurtherspecialist
surgeryisrequiredtoimprovethevoice.
Permanentdamagetobothnervesisveryrareindeedbutisaseriousproblem
thatmayhavetobetreatedbyputtingapermanenttracheostomy(breathing
tube)intothewindpipeintheneck.
Non-specificvoicechanges
Anyoperationontheneckcanproducesomechangeinthevoiceevenwhen
thereisnoinjurytothenervescontrollingmovementofthevocalcords.
Fortunatelythisvoicechangeisnotnormallynoticeableandrecoverswithina
fewmonthsoftheoperation.Youmightfindyourvoiceisslightlydeeperand
youmightexperiencevoicefatigue.Thisissignificantmainlyforthosewhouse
theirvoiceforprofessionalreasons.
Lowcalciumlevels
Insomecases,afterparathyroidsurgery,calciumlevelsmaydroptoolow.Thisis
almostalwaystemporarywhilstthebodyregainsbalanceofcalciumlevels.Your
surgicalteamwillcheckforthispostoperatively.Ifyoufeeltinglingorspasmsin
yourlips,fingersortoesaftertheoperation,thenthiscouldbeanindicationthat
yourcalciumlevelsmaybelow,andyouwillneedtoseekattentionfromyourGP
oryoursurgicalteam.Youmaybeprescribedcalciumtabletstemporarily.
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CalciumLevelsRemainingHighDespiteSurgery
Occasionally,inaround3to5operationsoutofevery100,thebloodcalcium
levelsremainhighdespitepatientsundergoingsurgery.Thisindicatesthatthe
operationhasnotbeensuccessfulincuringthecondition.Yoursurgeonwillnow
explainwhathappensnext.Thismayinvolverepeatingthetestsandscansyou
havealreadyhadtoseeiffurtherinformationmaybegained.Occasionally,more
involvedtestsarerequired,andifthisisthecaseyoursurgicalteamwillexplain
thesetoyou.
Bleedingaftertheoperation
Thisisanuncommoncomplicationthatcanleadtoneckdiscomfortor,inmore
severecases,breathingdifficulties.Occasionally,patientswillneedtoreturnto
operatingtheatreandhavefurthersurgerytohavetheneckexploredsothatthe
causeofbleedingcanbedealtwith.
NeckNumbness
Somepatientsmayexperiencenumbnessaroundthesurgeryscaraftertheir
operation.Thisusuallysettlesinthefullnessoftime.
Swallowingdifficulties
Followinganeckexploration,youshouldbeabletoeatanddrinknormally,but
somepatientsfeelasthoughthereisalumpintheirthroatastheyswallow.This
iscommonandwilldisappearintime.
Scar
Sometimesthescarmayberedforafewmonthsaftertheoperationbefore
fadingtoathinwhiteline.Ittakesaboutsixmonthstooneyearforthescarto
reachitsfinalappearance.Somepatientsmaydevelopathickexaggeratedscar
whichisunsightlybutthisisveryrare.
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Woundinfection
Infectionisnotcommonbutifithappensitcanbetreatedwithantibiotics.
Wouldswelling
Somedegreeofswellingaroundthewoundisnormalfollowinganytypeof
surgeryincludingparathyroidoperations.
RisksofGeneralAnaesthesia
Modernanaesthesiaisverysafeandseriousproblemsareuncommon.All
anaesthetistsintheUKarefullyqualifieddoctorswithspecialisttraining.
Itisnotuncommonafterananaestheticforsomepatientstofeelsickandfor
sometovomit.Certainpeoplearemorepronetothisproblem,andyour
anaesthetistwillgiveyoumedicationthatdecreasesthechanceofthis
happening.Otherproblemsthatcanoccurincludesorethroat,dizziness,blurred
vision,headache,itching,aches,painsandbackache.Theseproblemstendtoget
betterwithinafewhoursofwakingup.
Lesscommonproblems(1in1000patients)includedevelopmentofachest
infection(particularlyinthosewhoalreadyhavechestcomplaints),muscle
pains,damagetoteeth,lipsortongue,ortheworseningofanexistingmedical
condition.
Veryuncommonproblems(1in10,000patients)includedamagetotheeyes,a
seriousdrugallergyandnervedamage.Theriskofawareness(remaining
conscious)whilstunderageneralanaestheticisveryuncommon(also1:10,000).
Whenawarenessdoesoccur,itistypicallyforashortperiodpriortothe
operationcommencing.Itisextremelyraretobeconsciousduringtheoperation.
Therisktoyouasanindividualwilldependonwhetheryouhaveanyother
illness,personalfactors(suchassmokingorbeingoverweight)orsurgerythatis
complicated,takesalongtimeorisdoneinanemergency.
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Pleasediscussanypre-existingmedicalconditionswithyouranaesthetist.In
certainsituationsyouranaesthetistmaywanttoseeyouafewweeksbefore
youradmissiondatetomakesuretherearenoproblemsthatneeddealingwith
beforeyouroperation.
Formoreinformationaboutrisksassociatedwithyouranaestheticyoucan
eithercontactyourAnaesthetistthroughyoursurgicalteamorvisittheRoyal
CollegeofAnaesthetistswebsiteatwww.rcoa.ac.uk.
TheBritishAssociationofEndocrine&ThyroidSurgeonsisindebtedtoDrAdamDobsonConsultantAnaesthetist,UniversityHospitalofSouthManchesterwhohelpedintheproductionofthisleaflet
Disclaimer
Theadviceinthisleafletisbelievedtobetrueandaccurateatthetimeofgoingtopress.
Ultimately,theresponsibilityforobtaininginformedconsentfromyouforasurgicalprocedure
lieswithyoursurgicalteamandnotwiththeBritishAssociationofEndocrine&Thyroid
Surgeons(BAETS).
BAETScannotacceptanylegalresponsibilityforthecontentsofthisleafletwhichisproducedin
goodfaith.