Postoperative FAQ's

We make a small incision on the front of your neck to do this procedure, but we have to pull on the muscles of the neck in order to see all of the structures we need to see. We expect that those muscles will be sore for some patients for a day or two. Everyone is different, so we encounter some patients, every few weeks, whose muscle soreness will continue as long as a week after surgery despite taking ibuprofen and/or Tylenol and using an ice pack. In these patients, swallowing is uncomfortable as well. You can eat and drink whatever agrees with you (soft things like milkshakes, mashed potatoes, oatmeal). You won't hurt anything if you move to solid food. The soreness in the neck always gets better. Alternating 600-800mgs ibuprofen (Advil, Motrin) with 2 Extra Strength Tylenol every 4 hours works well for moderate pain. Smoothies, Popsicles, and Ice cream really help with a sore throat. Sometimes the device anesthesia uses to help you breathe during surgery can cause your throat to be a little sore for a few days and these things will help to soothe it.

The surgery can also cause referred pain up to your ears or around to the back of your neck. Heat is helpful for the back of your neck along with ibuprofen and gentle massage. This may last up to a week or so depending on how your body recovers.

For most patients this goes away right after surgery and does not return. However, there are some in which it returns. These may be patients with osteopenia/osteoporosis and causes by the remodeling process. Magnesium typically takes care of this. We recommend about 400mgs at bedtime (please see section on Magnesium).

Taking an extra dose of calcium can sometimes help us. If your only complaint is leg cramps, particularly at night, and are not experiencing low calcium tingling or numbness, we suggest you add Magnesium at bedtime. Magnesium helps with the calcium metabolism in and out of your muscles and typically helps with the cramps. If they are severe or happening more frequently and/or present in other locations, please give us a call.

Not usually. You will need to remove it 1 week after surgery. Just get it nice and wet either in the shower or with a washcloth, grab a corner and pull it off.

You don’t have to put anything on it but if you choose to we have a few recommendations. The most important thing is to protect it from the sun so a scar cream with sunblock in it like Mederma is a good option. You can also use vitamin E oil or silicone sheets or gel if you’d like. You may use these 24 hours after the steristrip is removed.

Yes. You can reinforce the dressing with gauze pads and tape or a large Band-Aid to catch drainage to protect your clothing.

Yes, this is normal. It can show up a day or two after surgery and stick around for a few weeks to a month or two. Everyone heals a little differently. It can be as small as a marble or as large as a golf ball. It should be completely gone by 3 months postoperatively. If not, please call us. Nothing you do can speed up this process.

This can happen, although it is rather uncommon. In general, while this is no fun to look at, it is typically not a medical threat to the patient. Most commonly, this is something that would occur if a patient is taking a blood thinner or that bruise easily. Even small amounts of blood accumulating under the skin of the neck can spread to the top of the chest. Gravity can push that downward. The main thing to know is that this is a superficial development; whereas important anatomic structures are deeper than this and are almost always unaffected by it. The bruise goes away, after changing colors a few times, over the course of a few weeks.

Recommendations for this are variable. When you leave the recovery room, you will be provided with an ice pack that ties around your neck, so you don't have to hold it in place. Our nurses will usually recommend “15 minutes on and 15 minutes off.” Some patients do “30 minutes on and 30 minutes off. “The main point is that you want to use it as much as you can after surgery until you go to bed that night. You do not have to sleep with it on your neck. The ice pack doesn't do a whole lot after the first afternoon and evening, but you should hang onto it in the event that you have soreness beyond the first day. Some people find that the ice helps with that particular problem.

This is usually because the plastic LMA has rubbed the back of the tongue and throat. The mild irritation that results can make patients cough for a few days. This is something we would want to know about to make sure it is nothing more serious. You will be provided with phone numbers to call to speak with our nurse and with our cell phone numbers to speak with us directly. We typically recommend drinking plenty of fluids to keep the secretions thin and easy to clear and coughing and deep breathing. Occasionally a cough medication is recommended but we will discuss this when you call. This is when you would want to avoid ice cream until the phlegm production resolves as it can contribute to the problem. Do not worry that you may “bust a stitch” when you are coughing. This is very unlikely. However, if you splint your neck when you cough with your hand or a folded towel, it will often help with the discomfort.

Yes. Thousands of little titanium clips are used in surgery throughout the United States every day. They are used to close blood vessels that need to be divided. They stay in your neck permanently. They are no harm to you whatsoever. They will not interfere with an MRI and will not set off the metal detector at the airport! We do not document when they are used or how many so the nurse cannot give you this information.

There are many different forms of Magnesium. Magnesium Oxide is the most common form found in most pharmacies. However, it can cause GI upset, especially in those that already have irritable bowel issues. A few better options with less GI upset are Magnesium Glycinate, Malate, and Gluconate.

400-500mgs at bedtime. It can make you sleepy which is why we recommend you take it in the evening. The tablets can come in 250mg, 400mg, and 500mg doses depending on type and brand which is why we give a range.

You should take calcium as long as you have decreased bone density and your calcium values are less than 10.1. You should take Magnesium as long as you are taking calcium supplements unless you have negative effects from them.

Yes, you can switch to a comparable supplement (same dosage) after you have been on your maintenance dose of 2 calcium ppd for a few weeks and not experiencing any low calcium supplements. Of course, if you are having issues with the calcium supplements, please call to discuss.

We prefer Citracal Maximum Plus. We have 25+ combined years of experience with this particular supplement. We will ask that you purchase a bottle of this from your local grocery store/pharmacy and bring it along with you the day of surgery. We will give you printed instructions about exactly how much we want you to take. Once you get past the first couple of weeks, then it really doesn't matter which brand of calcium pill you take. You can crush these pills in some juice, apple sauce, or pudding or break them in half. You can also crush them and add to a medicine cup with a little water. You can of course break them in half as well.

We recommend Centrum Silver or Women's 1-a-Day (yes, you can take this one even if you're a man). There are several nutrients that are necessary for bone health in these multivitamins, like magnesium, zinc, vitamin D, and calcium. These vitamins have a little more calcium and Vitamin D than standard multivitamins.

Maybe. Of course, most high blood pressure is what is known as essential hypertension and is caused by other factors (obesity, genetics, excess salt intake, etc.). Primary hyperparathyroidism is known to cause hypertension. Getting the parathyroid problem fixed by removing the tumor is always recommended. Patients should then work with their primary doctor back home a few months after surgery to see if some of the medications (or all of them!) can be discontinued.

Unless you have severe osteoporosis, we recommend taking a break from these drugs for the first year after the parathyroid problem is cured. Virtually every study shows the bone-building benefit of parathyroid surgery to be greatest for the first year after surgery. Just go with science: stop these medications, take the recommended calcium and vitamin D supplements, and get a bone density scan in a year to 18months to see how much ground you have gained.

Yes, they can cause constipation even though the brand we recommend is the least constipating form. You should make sure you stay well hydrated. We recommend 400-500mgs Magnesium daily, Miralax, Dulcolax, and/or a stool softener. Make sure you are eating plenty of fruits and vegetables. Enemas are last resort.

Yes. We will typically recommend switching to calcium carbonate if this happens, one with vitamin D in it as well. The brand we recommend is Caltrate. This form can be more constipating so if that happens once you begin this form you would just alternate the Citracal and Caltrate.

Calcium citrate can cause heartburn if taken on an empty stomach which is why we recommend taking it with food, at meals and an hour before bedtime with a snack. Drinking milk can help with this as well.

This is typically within the first 24-48 hrs following surgery from the anesthesia. They usually give you something to help prevent this before surgery, but it does not work for everyone. Staying well hydrated and getting plenty of rest are the first step. Also, make sure you are taking your calcium with some food, even if it is a few saltine crackers. Ginger really helps with nausea. Some recommendations are ginger ale (with real Ginger), ginger tea, ginger supplement or candys are all good. If you are experiencing significant nausea and it is causing vomiting, please call us.

It is important to space your thyroid medication 4 hours from calcium. If you are taking increased amounts of calcium during the first week or two, we recommend taking your thyroid medication in the middle of the night if you get up to go to the bathroom. It isn’t as important during the first week or two to space them 4 hours apart, but it will long term. Calcium can interfere with your body's ability to absorb the thyroid hormone.

Some other medications that calcium could affect absorption of are some antibiotics particularly fluoroquinolones which should also be spaced 4 hrs from the antibiotics. If you have any questions about specific medications and calcium supplements, we recommend consulting your local pharmacist.

The thyroid gland and the parathyroid glands are next to one another in your neck, but their function is completely different. Your dose of thyroid hormone should not be impacted by parathyroid surgery. You should continue taking your thyroid hormone after your surgery.

You can eat as soon as you wake up. You can eat anything you like, although most patients will stick to soft foods like ice cream, oatmeal, mashed potatoes, etc. You can exercise the next day if it is light exercise like jogging. We don't recommend that you do any heavy weightlifting for at least a week. Tennis players and golf players may want to take the week off as well. Looking up to the sky sometimes pulls on the neck muscles. Just listen to your body on this. You can drive the next day (the anesthesia drugs will have worn off). You may not fly the same day as surgery, but we recommend patients fly home the next day.

You can shower the next day and swim after 48hours

It typically takes 2-5 business days for path reports to result. You can view them in your MyChart account. We will only call you if something is abnormal. Your doctors will also receive the reports.

No. Parathyroid tumors are benign. They do not break off and spread to another part of the body (metastasize) like cancers do. In all these years of doing parathyroid surgery, we have only seen two cases of parathyroid cancer—that's how rare it is.

If we want to have the highest possible cure rate, then yes. These tiny, meticulous little biopsies of the remaining parathyroid glands are done so that we can confirm that they are normal. There are a number of components of curing this problem for you, and this is one of them. This is what we do better than anyone! Not only find the tumor and remove it, but we find the remaining parathyroid glands and confirm that they are normal. This is why your doctor wanted you to see us.

We remove the whole parathyroid gland with the tumor attached. The best way to think of this is not that a tumor grew ON your parathyroid gland but think of it like your parathyroid gland has BECOME a tumor. Remember that we are all born with four parathyroid glands, so removing one or two (or three!) parathyroid tumors still leaves you with one or more normal parathyroid glands, which is more than enough to live normally. Only in very special circumstances will we remove the tumor and leave some of the parathyroid gland inside (i.e.., if we think that might be the only parathyroid gland you have left after previous surgery removed the others).

You will be given printed instructions detailing exactly how much calcium we want you to take by mouth after surgery. We expect that your calcium will fall once the tumor is out, so having some mild symptoms is actually expected. By and large, patients who still get symptoms of low calcium will get them on the second or third day after surgery (not the night of surgery or the next day!) Most commonly the symptoms are tingling/numbness in the fingers, lips and cheeks. Most everyone will be able to relieve the symptoms by simply taking extra calcium pills. On rare occasion (quite rare actually), calcium pills are not enough to control the symptoms, and the patient has to actually receive calcium through an IV. This is several days after surgery, if it happens at all. Now you see why we urge people to have surgery with us and return home the next day. If you are one of those rare individuals who needs more than just oral calcium to help get your calcium balanced, you would rather be near home, not trying to work out of a hotel room in an unfamiliar city, rearranging flights, etc. While the expertise you get from us surgeons here in Tampa is unmatched, patients can get calcium pills or calcium through an IV anywhere in the civilized world. Obviously, you will be given our cell phone numbers and email addresses, as well as our nurse’s phone number, so that we can guide you through what is usually an easily managed problem.

Of course, the answer is: "It depends.” If one of your presenting symptoms is bone pain (deep constant aching in the arms, hips, and legs and sometimes feet, hands, and lower back), then you should not be surprised if your relief is almost immediate after waking up from surgery. This is one of the most gratifying things we see in our chosen field of parathyroid surgery! Bone pain relief comes very quickly after the tumor is removed and the PTH level falls. Other symptoms like fatigue, memory loss, difficulty with concentration and sleep, moodiness will usually see some improvement in about the 10–14-day range. Symptom resolution is not always predictable, but most everyone will see some improvement, whether it is 20% of their symptoms getting better or 90% of their symptoms getting better. For many patients with parathyroid disease, any improvement in the symptoms is a welcome development.

This can take about 6-9 months to see improvement. Sometimes a little longer.

The remaining parathyroid glands almost certainly will wake up again. We take great care and precision in making sure that we not only fix the parathyroid problem but that we preserve enough normal parathyroid tissue that the patient can enjoy life normally after surgery.

You don't have to see your doctor back home until two months after surgery. We will provide you with an order for the blood work we want you to get at the 2-month mark. Some people get this done at their doctor's office and see the doctor at the same time. Others just take the order form that we have given them straight to the lab to get their blood tests done. The lab will send us the results. This timeline is not set in stone. If you see your doctor at six weeks, or you live part of the year in another state and won't see your regular doctor for another five months, it is also OK. You have our contact information to help guide you through anything that should come up after surgery if you need to reach us. If you do not hear from us with in a week or two of getting your labs done, please call us to make sure we received the results.

Yes. Your doctors will receive copies of your operative report (the detailed medical report describing what we found and what we removed), the pathology report from the lab, and a letter from us summarizing your care with us. These documents usually arrive 1-2 weeks after surgery.

Operative and Path reports can be found in your My Chart account. If you cannot find them there or do not have access, you can also obtain the records by emailing requests to roirequests@tgh.org.

The request should include your name, date of birth, dates of service, and specific information needed.

No. We just ask that you do not take any calcium supps 2 hours prior to the test.