General Questions

Can my family stay with me?

Yes, your family is welcome!

Some people come by themselves for parathyroid surgery and that is perfectly fine. But most people bring a family member or two with them to the hospital. If somebody comes with you, we strongly suggest that they download this app also so they can read about what is happening at all times. It really helps them and keeps them relaxed knowing where you are in the process, what is happening, and what is coming up next.

If you are by yourself, we will ask you if there is anybody back home you would like us to call when your operation is completed.

Family / friends can stay with you

Your family members can be with you throughout almost all of the day. You will leave them for a few minutes at the start of your time with us when you to get an IV in your wrist/arm and so you can change your clothes. They will be able to sit with you after that and keep you company and participate in all of the discussions with the surgeons / nurses.

You will leave your family again for about 30 minutes when you go for your scan, but they typically will chill in your assigned room watching TV or reading. They do not go to the scanner with you (there isn’t room for them in the scanning room, and there are other patients being scanned as well).

Food for the family

If you are one of the first 6 patients of our day, we typically have your family / friends hang out in your room until you go to the operating room, and then we send them down for breakfast in the cafeteria. If you are patient 7 or later, we typically send your friends/family for breakfast while you get the scan.

When you go into the operating room we will send your family out to the waiting room or to the cafeteria (which is very nice and right down the elevator from the Parathyroid Center).

Surgeons talk to your family after surgery

Once the operation is over, one of the surgeons will come to the waiting room to find your family and give them your photo and let them know you are doing great. This is typically just over 1 hour after they left you. And then, after you wake up and feel like chatting (usually about 1 hour after the operation is over), you will change into your regular clothes and your family/friends can come back to join you again for the last 30-45 minutes with us. This allows your family to participate in the final visit with the surgeons and be a part of the last instructions we give you.

Have your family get this app

Have your family download this app for themselves. It won’t have a few personalized things that yours does, but they can have access to all of this information and they will be happier knowing what is going on. They use it as a visitor and it is about 95% the same.

What your family should bring

The people coming with you should bring something to keep them occupied. A book, a computer, or somebody else to chat with. They will be with you most of the time, but obviously you have other things to do. Your little room has a TV that they/you can watch (the remote is attached to the long white wire). We have WiFi for everybody (TGHguest) so they can get some work done on a computer.

We will send your family off to the cafeteria while you are getting your operation. The cafeteria is actually quite nice, and is located on the first floor right below the Parathyroid Center (you walked by the cafeteria getting to our elevators). However, we have noticed that some family members / friends bring some snacks along with them. It is OK for them to have snacks in your room, but we don’t want them to bring entire meals up into the patient areas (our doctors will eat it if they do!). Small snacks are a great idea for your family to bring, but you can’t have any!

Starbucks

We also have a Starbucks Coffee in the hospital. This is on the first floor, but not near the cafeteria. If your family wants Starbucks, the head to the first floor and start walking.  Anybody can point them in the right direction.

Want more details?

We discuss a lot more about this kind of thing in the Yellow “Day of Your Operation” section 2 of the app.

Can I come for surgery by myself?

Sure!

Most patients come with family or friends, but usually once a day we have somebody that comes to the Norman Parathyroid Center all by themselves. Parathyroid surgery is pretty simple the way we do it. We’ve had thousands of patients travel to Tampa for parathyroid surgery by themselves and they do great.

Safety is always the biggest concern. We look after you a little different to make sure we know where you are going and you are perfectly ready to take care of yourself. 

If there is someone back home that you want us to call after your operation, just let us know. We’re happy to make a call or two for you. You can also call them when you wake up. Cell phones are allowed.

Do I take 1 calcium pill or 2?

This is a question we get when people read the small print on the calcium bottle which says there is “630 mg of calcium citrate per dose, and a dose is 2 pills”. We have learned from putting tens of thousands of patients on calcium that the best and easiest way to do everything in “pills” not calcium milligrams.

When we say to take 5 pills per day, that means 5 pills per day… not 10 pills per day.

Can I take generic calcium pills?

Yes!

With very few exceptions, patients who have a successful parathyroid operation need to be taking calcium pills after the operation. Although we talk about Citracal brand of calcium citrate, we are quite happy if you get a generic brand of calcium citrate. We would prefer if you get one bottle of the Citracal for the first week, and then switch to the generic form. There are lots of generic forms, some of them are shown here in these pictures.

Make sure it has vitamin D

Every pharmacy and almost every grocery store has calcium citrate. Always get the calcium that has vitamin D, because the primary job of vitamin D is to help your intestines absorb the calcium.

Make sure the amount is the same. 

Throughout this app, and with the written materials handed out at the Norman Parathyroid Center, we talk about Citracal maximum strength. This has 630 mg of calcium citrate per dose, which is two pills.  Of course, we always discuss taking “pills”, and that means pills, not doses. If we say take 5 pills, that means 5 pills, not 10 pills. So get the generic form that has about 315 mg calcium citrate per pill (630 per dose, where a dose is 2 pills). Any questions, bring your calcium with you to the hospital and show it to one of the three surgeons that will be with you on your surgery day.

Headaches after the operation

Some people have a headache when they wake up from anesthesia. This can last a few hours but it always goes away. There is nothing to worry about; it isn’t dangerous, it is just some people get it.  The key here is to know that it is temporary and will go away. The most important thing to do is to drink lots of water and stay well hydrated. If you have a headache in the recovery room, you can elect to stay a little longer with us, or get back to your hotel so you can lay down and try to sleep. Typically the best way to get rid of the headache is to get back to the hotel (or your own bed!), make the room dark, and get some sleep. Typically Ibuprofen (Motrin, Advil) work much better than Tylenol. Trust us on this!

About 1 patient out of 100 will get a few headaches during the first two weeks after the operation. You are going through hormone shifts and some people tolerate this differently than others. It is perfectly OK to take whatever pain medications you want. Ibuprofen, Motrin, Advil and Aleve are our favorites. Tylenol is ok but most people do better with the others. Again, this will go away and it is not a sign of something being wrong.

How long do I use an ice pack?

On for 30 minutes, off for 30 minutes

We provide every patient with an ice-pack to put on their wound to help keep the swelling down. Our nurses will put fresh ice in it just before you leave. We want you to use this 30 minutes every hour (30 minutes on, and 30 minutes off). We are quite happy if you decide you want to keep it on for an hour or more at a time if that is what you want to do. However, we have found that the ice doesn’t help much after the first day. So our recommendations are to stop using the ice-pack at bedtime the day of surgery. If you feel better using it the next day then feel free to do so, but most people should use it only the day of surgery.

You will get blood on the ice pack

Don’t freak out if you get a little blood spot (or a few) on the ice pack. This is perfectly fine and we expect it to happen!  So please don’t call us about some blood spots on the ice pack… it makes us pull our hair out!   This is supposed to happen.  No worries!

How long should I stay in Tampa?

Traveling by car

If you are traveling by car, you should feel free to get in the car after your operation and drive on home. Of course, you can’t drive, but you can be a passenger. If you live in Florida and are traveling by car, you should plan on driving home the same day, although some patients do choose to stay the night of surgery in Tampa. Remember, the first 3 patients of the day can expect to be out of the hospital by 9:45 am, so traveling home by car is easy. However, patients who are the last ones of our day may not leave the hospital until 6:00 pm or so. These later patients should plan on staying in the Tampa area if they have to drive more than an hour or two.

Traveling by airplane

About 65% of our patients live outside of Florida, with about 8% living outside of the United States. Thus, way more than half of our patients fly to Tampa for their operation. We recommend flying home the day after the operation. We do not recommend flying the day of surgery. Trust us, we’ve done this well over 30,000 times. Spend the night of surgery in Tampa, (or drive to Orlando, or the beach, or somewhere else in Florida), and then fly home the next day.

Flying to other countries

If you have flown into Tampa from another country, you can still plan on flying home the day after surgery. Interestingly, most elect to spend one more day in Tampa going to the museum, to the Aquarium, to the Dali Museum, to the beach, or to Disney. But you can feel free to fly back to another country the day after surgery if you chose.

When will I start to feel better?

Parathyroid surgery changes lives–in almost all cases.

The vast majority of patients undergo a change in their life and how they feel after parathyroid surgery that is often times described as a miracle. Chronic fatigue and aches and pains are very common in patients with hyperparathyroidism and this almost always goes away. We give back the “joy of life”!

Miracles happen at different rates

Keep in mind the tortoise and the rabbit. People recover at different rates. The rabbit peels out right out of the gate (the patient who feels fantastic the very next morning and can’t wait to tell the world how great they are doing!). They run way ahead of the pack, and when they get near the finish line, they are the loudest and the happiest. Good for them!

Most patients (“the pack”) will notice the difference somewhere around 7-10 days after having a tumor removed. They are not way up front with the rabbit, but they’re surely not trailing way behind the pack where the tortoise is. There is nothing wrong with you if you are in the pack. How about the tortoise? The tortoise is going to get there, too. He’s just going to take his sweet time (maybe 6-8 weeks). So don’t panic if you don’t wake up a completely new person the morning after the tumor is removed. Most people don’t.

Symptom resolution

Certain symptoms get better at different times. Memory loss, mental sharpness, energy levels, concentration abilities, mood stability – these things typically start to get better between 7 and 14 days, on average. Some people don’t feel any different for a month or two. Think about it: your nervous system has to get used to a normal calcium level again. Your brain has not seen normal calcium levels for years. Remember, this disease occurred over a period of years; some things will take days to get better, but some things may take months to get better.

Bone pain gets better almost immediately–within an hour or two. Clearly, this is the most gratifying thing to observe. Attention all rabbits! This may be you!  Fatigue (the number one complaint by far) is 7-10 days as noted above. Hair loss in women takes 6-9 months, but it will get better.

Most people can expect improvements in their blood pressure, so discuss this with your doctors. Many of you can expect to decrease your blood pressure medications (some will be able to eliminate these drugs) over a period of 3 to 12 months. This can take a long time in some people as your cardiovascular system heals. Ask your doctor to monitor you for this improvement and the opportunity to get off some medications. The same goes for heart medications and heart rhythm problems.

Feeling a little weird the first week

You’re going to have hormone shifts in the days and first few weeks after the operation. Hormones are powerful things, and many of them interact with each other. So while you’re having a change in parathyroid hormone, this may show itself in the first few weeks that follow surgery with some strange feelings every now and then. This is a GOOD thing, not a bad thing! No worries, it goes away!

Most people never have any of the problems that we talk about here. Many go out to dinner the night of surgery. Most feel pretty darn good the next day and don’t have any negative effects from the surgery. However, an occasional person will feel “blah” for a few days, or even a few weeks. If you feel bad for a while, just remember we needed to change your hormone levels! As we always tell folks who feel a bit poor or bad for a few days or even a week or two–”We took a tumor out, we didn’t put one in. It WILL get better!”

Most people feel just fine in a day or two

We’ve taken care of tens of thousands of patients with hyperparathyroidism and have seen what happens in the days and weeks after the operation. Most are back to their regular selves within a day or two, and then feeling better a few weeks later than they have in years. Some people take longer. If you are one of them, no worries! You are running with the pack! As we say to almost every patient: there really is no bad news, just good news! You will get through this just fine!

How do I write a review of NPC?

We love our patients, and our patients love us!  The doctors, nurses and staff of the Norman Parathyroid Center are very passionate about parathyroid disease and are trying to teach people world-wide.

Positive reviews online are very important

People often thank us for taking care of them, and ask “what can I do for you?”  The answer is: Positive reviews online are very important to us and we would love for you to tell other patients about the great experience you had at our center.

SECTION SIX OF THE APP

Hurts a little when I swallow

Sometimes a patient will contact us a few days or a week after the operation and say “It feels like something is stuck in my throat. Is this normal?”  Yes, this is normal and can be present for a few days, and very rarely for a week or two. Do not worry about this. You are still healing!

All the stitches we use will dissolve

The muscles in your neck are healing, and during that time things can feel sore or “tight” when you swallow. It always gets better. Sometimes swallowing can feel “different” for a few weeks after the operation – this is normal too and will improve as everything heals. Remember, even if your incision looks perfect on the outside, there is still a lot of healing going on inside your neck for weeks after the operation (which is true for every operation, anywhere in the body). The tissues were sewn together with stitches that dissolve over 3-5 weeks, so give it time. It will get back to normal with time as it heals.

If this is bothering you, then please take 400mg of Advil (ibuprofen, Motrin) daily for a few days. This will help with the healing and inflammation. Time will make it better!

Nausea after the operation

We know that some people get nauseated after anesthesia. We take several measures to make sure this doesn’t happen to you—we don’t like it when our patients are nauseated! Overall, we get about 2 people per week (less than 5%) that have nausea after their parathyroid operation. We have tricks that we use for everybody to make sure this is as rare as possible.

What causes the nausea?

First, know that the anesthesia that some people get after the operation is caused by the anesthesia drugs, and a short, quick operation means less drugs. Thus, many patients who experienced nausea with previous operations will not get it at our center because our operations are quite fast and thus you don’t need as much of these anesthesia drugs.

We take steps to prevent nausea

We also give all of our parathyroid patients an IV medication in the operating room to cut down on the incidence of post op nausea. If you have a history of nausea with anesthesia, we can also give a Scopolamine patch behind your ear to help decrease the chances of nausea. You should remove this patch the day after surgery. Make sure to wash your hands after you touch it!

It is very rare for the nausea to last more than a few hours or into the next day. If it does, please know that it will go away soon and you should try to keep liquids down. The best trick is to drink Gatorade and/or water and eat crackers. Ginger is a great medicinal for this purpose, so many people swear by ginger-containing foods like ginger-ale, and ginger candies.

I’m coughing up a lot of phlegm

Yuk!

This is not common at all, but after the parathyroid procedure, a few people might notice that you need to cough up extra mucus for a few days. Less than 1% of our patients have this problem, but they all tend to think it is a problem so they call us. This is not a problem. This is normal and is not a sign of infection or any other kind of trouble.

Drink lots of water to keep the mucus thin also makes it go away faster. Big picture, we operated on the inside of your throat. It will be sore a little and cause some extra mucus. This is not a big deal and not to be worried about.  If it lasts more than a week or is associated with a fever, then consult your physician–this won’t be related to the operation at all.

Is there best time to take calcium?

Parathyroid patients take calcium after surgery

Your intestines can only absorb so much calcium at a time, which is why we recommend spreading the calcium throughout the day. When you are down to two pills daily, you can take these together and this can be done at any time of the day. But when on 4 or more pills per day, spread them out during the day.

Should I get up at night?

No, it is not necessary to wake up in the night to take your calcium pills. It takes the body 4-5 hours to completely absorb a calcium pill. The pill you take now is still in your intestines for hours. Thus, you should save one of your calcium pills for bedtime so it is being absorbed all night long. And then, take the next one first thing in the morning.

Magnesium and multi-vitamins

Parathyroid patients need multi-vitamins

You can take any multivitamin after your parathyroid operation, but something like Centrum Silver or Woman’s One-A-Day are great (for men and women). If you have significant bone loss (and most people with a parathyroid tumor do), you should also take a daily magnesium supplement. Magnesium is important for calcium metabolism and bone remodeling.

Many types of magnesium pills

There are lots of different forms of magnesium out there, and any of them will work. Note that magnesium has a laxative effect, and certain forms (e.g. magnesium citrate) are more often used to treat constipation. If you buy a magnesium that is meant to treat constipation (most often liquid magnesium citrate), the dosage will be higher than what you need, and will produce loose bowel movements.

We usually recommend taking either magnesium oxide or magnesium malate, which may also help with muscle cramps. Adults should get about 400 mg a day of magnesium. If you are requiring lots of calcium postoperatively, we recommend increasing the magnesium dose to 800 mg a day while you are needing the higher doses of calcium.

What multi-vitamin should I take?

We typically recommend that our patients take a multi-vitamin long term (for years) following a parathyroid operation. The parathyroid tumor(s) has removed calcium from your bones and your bones will heal themselves to some degree if we give them the building blocks they need to build new bone and restore the bone you have to stronger bone. It is important to understand that bones are living tissue, so they need the proper nutrients to be healthy.

Bones are more than just calcium

Although calcium is the major mineral within bone, good bone health also requires magnesium as well as some other trace elements like strontium. The best way to get these trace elements is by taking a good multi-vitamin every day. There are a number of good brands, but we still like the typical brands that are available almost anywhere like Centrum Silver and Woman’s One-a-Day. We like the ones that are intended for senior citizens even for our youngest patients because these formulations are designed to give more bone-related nutrients and that is why we are taking these pills.

When should you start?

We typically tell folks to start the multi-vitamin about 2 weeks after the operation, because we already put you on 5 or more calcium pills per day. But it really doesn’t matter; you can start your multi-vitamin pill a few days after the operation if you want.

Coumadin: when to stop and restart?

Coumadin (warfarin) is a blood thinner

Coumadin is a very commonly used blood thinner. The generic name is “warfarin”. Coumadin is frequently used for people with DVT (blood clots), and for people who have heart arrhythmias, such as A-Fib, or atrial fibrillation. Both of these situations are more common in patients with hyperparathyroidism–the parathyroid tumor can cause this.

Stop 5 days prior to parathyroid surgery

Coumadin has been around for decades, and for decades it has been standard for people to stop this drug for 5 days prior to surgery. This is what we do.

Re-start the evening of parathyroid surgery

For parathyroid surgery performed at the Norman Parathyroid Center, we prefer our patients to start taking their Coumadin (warfarin) the evening of the operation.

Can’t stop Coumadin? We are perfectly fine with that!

Some of our patients at the Norman Parathyroid Center are told by their doctor or cardiologist that they cannot stop the Coumadin. That is fine with us!  We have absolutely no problem whatsoever with performing parathyroid surgery on patients who cannot stop their Coumadin. We’ve done it hundreds and hundreds of times and to tell you the truth, we can’t tell the difference. We have never had a bleeding problem after one of our parathyroid patients because they were still taking Coumadin. The operation is exactly the same. There is no increased blood loss during the operation–we literally can’t tell during the operation if somebody is taking Coumadin.

So if your doctors are telling you that you need to stop the Coumadin and get started on heparin (a different blood thinner), then you can tell them this is absolutely not necessary at our Center. We operate on people who are still taking Coumadin at least once a week.

Bottom line for our parathyroid patients

Taking Coumadin poses a theoretical increased risk of bleeding during and for the first few hours after surgery. We prefer our patients to stop taking it for 5 days to decrease this potential risk. However, in the real world, our experience with hundreds of patients who are still taking Coumadin, is that it doesn’t affect the operation at all, and it can be done very safely. The risk is real, but it is very small. Having a parathyroid tumor in your neck poses a much higher risk!

Plavix: when to start and restart?

Plavix is a blood thinner that is pretty common. It is often used for patients with heart problems or those who have had a stent placed into a coronary (heart) vessel.

Plavix works great in preventing blood clots. We can tell that a patient is taking Plavix while we are operating on them. This is very different from Coumadin (warfarin) which is a different type of blood thinner that makes no difference at all during the operation.

Taking Plavix provides a theoretical increase risk of bleeding after all types of surgery. We have never had a patient have a postoperative bleeding issue or hematoma because they were taking Plavix (or Coumadin), but taking them does increase this risk. The increased risk is small because we do this operation all day every day and know how to avoid these problems in almost all cases.

We strongly prefer that patients are off of Plavix for 5 days prior to parathyroid surgery. However, if your cardiologist says you can’t stop it, then we will still operate on you to remove your parathyroid tumor. We do things a little different, but yes, we can still do your parathyroid operation if you are still taking Plavix.  We’d prefer not to, however.

When to re-start the Plavix?

If you stop Plavix 5 days prior to surgery like we want, then you can start it again the very next day after surgery.

Muscle cramps – is it low calcium?

Muscle cramping can be from low calcium, particularly if it is associated with the “classic” symptoms of numbness or tingling in the hands or face. In this case, it is happening within the first week of the operation and taking more calcium will help. If you are having prolonged muscle cramping or muscle spasms in your wrists or hands within the first week of surgery, you should take more calcium immediately and let your surgeon know, as this can be a sign of very low calcium.

More general muscle achiness is less likely to be due to low calcium if you aren’t also having symptoms of numbness and tingling. You should start taking a magnesium supplement if you are having cramps – this often helps even without taking more calcium. You can also try taking an extra 2 Citracal to see if that helps, but it may not, in which case you should not continue to take more calcium without speaking with your surgeon.

Muscle cramps after the first week

If you are having muscle cramps beyond the first week of surgery, we recommend starting a magnesium supplement, in addition to your calcium and Vitamin D. Magnesium is very important for calcium metabolism, and helps with postop symptoms. For muscle cramps, we recommend magnesium malate. Adults should get about 400 mg a day of magnesium. If you are requiring lots of calcium postoperatively, we recommend increasing that to 800 mg a day while you are needing the higher doses of calcium. It is also important to stay well hydrated for the first week or two after parathyroid surgery.

My throat is sore.

Most people are amazed at how little our parathyroid operation hurts. Most never take a single pain pill after leaving the hospital. However some people have a sore neck and sore throat after the operation for a day or two. This is normal and you should feel free to take your favorite or preferred pain medication for this.

Cold drinks!

We have also found that cold drinks and smoothies provide relieve more than hot drinks. This is also a great excuse to eat ice cream! Some people get the best relief by alternating ibuprofen and Tylenol every 4 hours.

Swelling around the incision.

Some swelling is normal and perfectly fine.

Swelling is a normal response of the body after any “injury”, no mater where it is located. Just as your ankle will swell when you have a twisted ankle, your neck will swell a bit after your parathyroid operation. Usually this is very minor and it just looks a little puffy. This is absolutely normal. This is supposed to happen!  Ignore it and it will be gone in a few days or a week.

Should I massage the scar?

Our parathyroid scars are pretty small. And, no, you do not need to “massage” the scar—that won’t do anything. It is also important to understand that there are a lot of stitches inside that are holding the tissues together and these stitches typically take about 4-5 weeks to dissolve. Relax and give it time—our incisions almost always look great in a few months. We have more on this topic in the Post Op Instructions section.

Hey, I have a ping pong ball under my incision.

“Hey guys, I have some swelling around and under my incision like a small ping pong ball. Is this normal? When will that go away?” Yes, it will always go away!  As we stated above, it is very normal to have swelling around the incision, often for a few weeks. The incision also may feel lumpy or and the skin may feel hard – this is all normal and will go away as everything heals. If you have a small lump under the skin, leave it alone. It will always go away when the stitches dissolve in a few weeks.

Took bandage off and wound is red

Redness is a normal part of healing. All wounds get red and look a little bit irritated when you take the bandage off one week after the operation, so you should expect some of this. It can also be itchy which is another normal aspect of healing. If this is bothersome, you can put some hydrocortisone cream on it for 1-2 days and it will clear up.

We have never seen a wound infection

We have never seen a wound infection following a parathyroid operation. That doesn’t mean it can’t happen, but the blood supply in the neck is very rich and we give all our patients a dose of IV antibiotics in the operating room. If you have any questions, take a picture and text it to us.

Do I get an antibiotic before surgery?

Yes. 

Most of our patients get a single dose of IV antibiotics right before the operation.

Should I keep taking blood pressure pills?

82% of parathyroid patients have hypertension

It has been known for several decades that hyperparathyroidism is associated with a much higher rate of blood pressure problems and hypertension. In fact, about twice as many of our patients are on blood pressure medications than their peers who don’t have a parathyroid problem.

Will my blood pressure get better?

There is good evidence that some patients will have improvements in their blood pressure after parathyroid surgery, but if this happens, it does so after 6-9 months (or even longer) after the operation to cure the hyperparathyroidism. So after your parathyroid operation you must stay on any blood pressure pills. Talk to your doctor about this and then about 4-6 months after the operation, the two of you should start looking for opportunities to decrease the number and strength of blood pressure medicines you take. Many of our patients are on 2 or 3 (or 4!) blood pressure medications. Those that are on multiple different BP meds are typically the ones that can expect to decrease their medications or stop one of them. Do not ever cut back on blood pressure pills without talking it over with your doctor who can monitor your blood pressure and any improvements if they come.

Should I take Fosamax or Boniva?

Parathyroid patients get osteoporosis!

This is another really good question and the right answer depends on how bad your bones are and how much osteoporosis you have. We know that if you have hyperparathyroidism then these drugs don’t help. Said differently, if you have been taking these drugs when your calcium was over 10.0 mg/dl (2.5 mmol/l) then the drugs probably didn’t do a thing. The PTH is far too powerful and it overcomes any good these drugs can do (including Boniva, Prolia, Fosamax, Actonel, Zometta, etc).

Most people gain bone density after surgery

Another factor to remember is that several good studies have shown that the average patient gains significant bone density for several years after parathyroid surgery, and the bones get better just by taking calcium and a multi-vitamin. There have never been any studies that show taking one of these “osteoporosis medicines” will increase bone density in parathyroid patients or increase the rate of improvement after parathyroid surgery.

Bottom line

The bottom line is that this is a decision for you and your doctors back home to make. Some of you will have excellent endocrinologists and they will want to work with you on this long-term. We are not a big fan of these drugs, unless you have pretty significant osteoporosis. Otherwise, we like to suggest that you wait a year or two and see how much progress you are making. If your bones are getting better without these drugs, then that is what we would recommend. Again, ask your doctor for advice here too.

Taking calcium with thyroid hormone

Calcium can be taken with other medications, with a few exceptions, most notably thyroid hormone pills. Do not take calcium at the same time as thyroid hormone because it can affect the absorption of the thyroid hormone. If you take levothyroxine, Synthroid, Armour, or any other form of thyroid hormone, wait 4 hours before or after taking the thyroid pill before you take the calcium pill. Taking calcium at the same time will mean that your body won’t receive the full dose of the thyroid hormone.

Really, is it that serious?

We have learned that it is just fine if we break this rule during the first two weeks of the operation when you are taking lots of calcium pills, so don’t worry about this for the first two weeks. But long term be sure to separate these by at least 4 hours.

If you are getting up in the middle of the night to go to the bathroom, this would be a good time to take your thyroid pill.

Other medications that can interfere with calcium

Other medications that should not be taken at the same time as calcium are: ciprofloxacin or other “-floxacin” antibiotics (wait 1 hour), tetracycline antibiotics (wait 4 hours), bisphosphonates such as alendronate (Fosamax) or risedronate (Actonel) (wait 1 hour). This list is not definitive, and if you have questions about any of your medications and its interaction with calcium, please ask your physician.

There is blood on my bandage.

Most patients get some blood on the bandage after a parathyroid operation. This is normal.  Ignore it . About half of patients will notice that the ice-pack we provide you to put on the wound gets some blood on it. This is common and is perfectly fine. Sometimes blood will seep out from the edge of the wound and get blood on your shirt or pillow case. This is not a problem and should not cause concern. There is no worry about a few blood spots on your bandage, or on the ice pack. There is no worry about any blood that could drip from the edge of the wound. These tiny drops of blood are fine and will stop within a few hours. Not a big deal at all. You can take a shower the morning after surgery and get the bandage wet. The water flowing over bandage will clean it all up. Yes, it is OK to get soap on the bandage the morning after surgery.

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Weird symptoms from low calcium?

Sometimes a patient will call and say “my fingers and my face feel weird, but it doesn’t seem exactly like what I read about the symptoms of low calcium after parathyroid surgery. Is this low calcium?” Symptoms of low calcium can be tricky, and don’t always fit the textbook descriptions. While the most common sensation is described as numbness or tingling in the finger tips or lips, other sensations such as vibrating, trembling, and just an odd feeling of the skin can also occur. Sometimes people will say that they think their body is vibrating.

Low calcium symptoms on third day

Few people get symptoms of low calcium. If you are one of those few, it almost always happens on the third day following surgery. It never happens the day of surgery! If it happens, it usually involve the fingers and the face first with some tingling, like you hit your funny bone. If it is 3 days after your operation, and you have a new numbness-like sensation in your hands, you can assume it is due to low calcium, and that you need to take more. Start with 2 extra Citracal.

Only one in 20 of patients operated at the Norman Parathyroid Center get any symptoms of low calcium, and it only lasts a day or two in almost all cases. We are saying this again, that the symptoms of low calcium usually start three days after parathyroid surgery. It never occurs the day of surgery or the next day. It is very uncommon two days after surgery. It is extremely rare for these symptoms to start 2 weeks or more after surgery. So if you had surgery a few weeks or a month ago and now notice some new numbness in your fingers, it is probably NOT low calcium.

Read our page on “what you need to know”

Most people make too big a deal about this. Although low calcium symptoms happen to only a small percentage of our patients, for some reason (human nature?), everybody is freaked out and thinks they will be one of the 4-5%.  Read this page “What You Need To Know About Low Blood Calcium”.

What are symptoms of low calcium?

A few of our patients will get symptoms of low calcium. If you do, you need to take more pills. Less than 1 in 20 of our patients gets these symptoms.

The symptoms of low calcium are:

• Tingling around your mouth, lips, nose and cheeks.
• Tingling in your fingertips.
• Cramps in your hands/wrists.
• Feeling like your body is vibrating.

Far too many of our patients worry about low calcium. It is usually a good thing, not a bad thing. It only happens in about 5% of our patients, and when it does it lasts about 2 days on average and is simply treated by taking some extra calcium pills. People read horror stories on Facebook and online–but those patients weren’t operated on here.

There is a lot more information on low calcium in the Post-Op Instructions section of this app, so click here if you want to know more.

What is maximum calcium I can take?

What is maximum calcium I can take?

People who are having a few tingles from low calcium occasionally get concerned that they are taking too many calcium pills. The call and ask “I going to overdose?” If you have been feeling low calcium symptoms and have started taking more calcium, you are probably wondering what the limit is. If you truly have low calcium, then there is no absolute limit – you need to take as much as you need—but we need to know.

We want you to give us a call when you get to 10 pills so we can chat about the symptoms and make sure you are doing the right thing. We want to make sure that it is really low calcium that is causing your symptoms, and not something else. We also want to guide you through how many pills to take each day and how to taper off that high dose once your normal parathyroids start kicking in.

When am I going to feel big change?

When am I going to feel big change?

Sometimes we get a call from a patient that is worried that their life didn’t change overnight after the operation. The will say “It’s been a few days since my operation and I haven’t noticed significant improvements. What’s wrong?” The answer is simple: Nothing is wrong.

Please read our Post Op Instructions and read the section about the Rabbit and the Turtle. Some people feel amazing in the days after their operation. But others don’t, and that’s OK. Your body has to adjust to a large shift in hormone and calcium levels, and some folks take a week or two to get over that. Over time you will feel the benefits of parathyroidectomy. It’s fine if you can’t feel the benefit in the first days or weeks. You will get there. You may be one of the turtles, but they get to the finish line too!

When and what can I eat?

When and what can I eat?

You can eat anything you want as soon as the operation is over. You will have no restrictions. We will give you a Popsicle and most people feel best when eating/drinking cold liquids. You can eat any food you want. You may want to have a nice celebratory dinner the night of surgery.

I’ve been on a low calcium diet for a while

Many people are put on a low calcium diet when they have high blood calcium. We don’t care much about this unless your calcium is above 12.0 mg/dl. But even if you are on a low calcium diet, you can stop that as soon as the operation is over.  So, if your doctors back home previously told you that you had to avoid calcium-rich foods, you can ignore this now. Your calcium problem is over and you can eat anything you want!  Calcium was the enemy, now calcium is your best friend. Let’s get those bones better!

Alcohol

Some people ask us if they can have a glass of wine with dinner after their operation. The answer is yes, depending on how you feel. Remember, you have some anesthesia drugs in your system so even one alcoholic drink will have a greater effect on you than normal. So be careful here and be smart. But if you are feeling good and are out for a nice dinner celebrating your successful operation, then feel free to enjoy with one drink.

When can I drive myself?

You can be a passenger the day of surgery, but you cannot drive yourself until the day after surgery. The anesthetic drugs that you are given will make you sleepy and have poor concentration and judgement.

We know that all of our male patients are excellent drivers, excellent drivers, but please let somebody else drive the Buick until the day after surgery.

When can I exercise?

When can I exercise?

We allow our patients to do pretty much anything they want starting the day after the operation. We suggest vigorous exercising should be delayed about 5-7 days, but yoga is fine the day after surgery as is long walks. Jogging is fine on day 3 or 4. You can go play golf around day 3 as well. Some people feel so good they play golf 2 days after surgery. Remember, if your neck hurts when you are exercising, then stop right away—your body is trying to tell you to stop! This topic is also covered in the blue “Post op Instructions” section number 3 of the app.

When can I fly home?

When can I fly home?

People who fly into Tampa should plan on coming the night before and leaving the day after. There is virtually no reason to stay another day, and we have had well over 10,000 people get on a plane the very next day and fly across the country, or across the oceans. If you are going to stay in Tampa, don’t stay for medical reasons—stay to go to the beach or to Disney world. You should feel very confident to purchase airplane tickets for the day after the operation.

When do I take bandage off?

When do I take bandage off?

We talk about this topic in the “Post op Instructions” Blue section #3 of the app. You can shower the day after surgery and get the bandage wet. Just pat it dry. The bandage should be removed on the 7th day after the operation. It may be hard to peel off, but do not leave it on more than 7 days. It often helps to take the bandage off after getting out of the shower when it is wet.

When do I get my stitches removed?

You don’t!

Virtually every surgery entails closing the wound with stitches. The muscles are put back together and the skin is closed. However, for several decades surgeons have used absorbable stitches and the days of going back to the surgeon a week later to have the stitches removed is gone.

The surgeons at the Norman Parathyroid Center use absorbable stitches throughout the operation so they will dissolve. There are no stitches to remove. They will dissolve and be gone in a few weeks.

I feel a little lump at the edge of the wound.

Yup, some people can feel this. This is the knot where the very small suture (smaller than a human hair) was tied to start the stitches. This knot is sometimes the last part of the stitches to dissolve. No worries! This will go away. Leave it alone. It is not dangerous, and not an issue (just a little weird!).

When should I get new DEXA Scan?

When should I get new DEXA Scan?

Because hyperparathyroidism takes calcium out of the bones, most of the patients at our Parathyroid Center have lower bone density than their peers. Some of you will have osteopenia, while others will have osteoporosis or even severe osteoporosis (if you have had a parathyroid tumor for 8 years or more).

Osteoporosis almost always gets better

Several large medical studies have shown that the bones of parathyroid patients get better in almost all cases after successful parathyroid surgery, at an average rate of about 8% per year increase in bone density. Thus almost everybody will get better bones in the years following parathyroid surgery even though they are getting older.

Because the process of gaining bone density is slow, we recommend that you wait 1 to 1.5 years after parathyroid surgery to check your bone density (a DEXA scan).

Never had a bone-density scan (DEXA scan)?

If you had parathyroid surgery and didn’t have a DEXA scan within the previous 2 years, then you should probably get one within a few weeks of the operation so we can have a baseline of how good or bad your bones are. That includes people who never had a scan.

If the tumor is out, why do I need a DEXA scan?

Well, it’s pretty simple. By the time somebody has figured out that you have a parathyroid problem (yes, we know that sometimes it is YOU that figures it out!), you have had a parathyroid problem for years. Just because you realized your calcium was high last year doesn’t mean you’ve only had a parathyroid problem for 1 year. The average patient we operate on has had a parathyroid problem for over 5 years before people figure it out!

Thus the parathyroid tumor has been taking calcium out of your bones for years. It’s gonna take years to put it back in. We put all of our patients on calcium after their parathyroid operation. And we tell them to take it for years.  Well that is pretty open-ended because how long the patient needs supplemental calcium is dependent upon the status of their bones.

If you are a 40 year old man and your bones are good, then you need calcium for about 6 months after the operation and that’s it. If you are a 65 year old post-menopausal female with a T-Score of -3.4 osteoporosis of the spine, then you are likely to be on calcium supplements for the rest of your life. Your bones are worse than your peers because you had a parathyroid tumor.

When should I see my doctor?

Some doctors want to see you within a week or so after the operation. We think this is too soon and prefer that you don’t worry about this for 6-8 weeks. We prefer you wait several weeks, preferably 6-8 weeks to check your calcium and PTH levels because it isn’t fully settled before this time. If you measure it 1 week later, the PTH is often a little bit too low because the normal glands you still have (which were asleep for years) haven’t fully woken up and started regulating things. So relax and don’t worry about checking labs or seeing a doctor for a month or two. Remember, we took a tumor out—we didn’t put one in!

What to tell your doctor?

We have an entire page for you to show your doctor when you go see them. First, know that your doctors will receive copies of your records from us about 7-10 days after the operation. They will get a letter from us, a photo, your hormone levels after the operation (the blood we drew from your arm about a half hour before you left), and a copy of the operative report which gives details of the operation, the thyroid, the other parathyroid glands, etc.  Show this page to your doctors: INSTRUCTIONS FOR DOCTOR PAGE 

Will you send records to my doctors?

Yup, we sure do!

About 5-7 days after the operation we will send a package to all of your doctors telling them about your operation. We will include a photo of the parathyroid tumor(s) we removed and on it a measure of how much hormone each parathyroid gland is making, PTH hormone levels taken from you about 30 hour after the operation (the white sticker on their photo), and a report on your other parathyroid glands and your thyroid gland (contained within the dictated operative report they will get). They will get a letter from us, and they will get a copy of the formal operative report and pathology report. They should already have this information when you see them at 4-8 weeks post-op.

Our expectation is that over 99% of our patients are cured for life.

Nobody cures 100% of patients, but we are very close, so we don’t expect to see you again. Of course we know who is cured before they leave the hospital in almost all cases because we 1) see and assess all four parathyroid glands in almost all patients (this is by far the number 1 way to know people are cured), 2) have removed one or more tumors from your neck (and you probably have a picture of them), 3) measured the amount of hormone being produced by each gland, removing the gland(s) that were over-producing PTH hormone, and 4) measured the PTH in your blood (out of your arm) before you left the hospital to see that it decreased appropriately. We aren’t guessing or hoping our patients are cured.

Did you know that no other doctors in the world take all of these steps to make sure you are cured? Did you know that 99% of surgeons “cheat” by removing only the parathyroid gland that shows on the scan and then they quit? Did you know that as many as 30% of patients who have this simplistic approach will need another operation within a few years?

Show the “Instructions for Your Doctor” page to your doctor

This app has a page that we want you to show to your doctor. It has the post op instructions about calcium, PTH, osteoporosis drugs, etc. It also has a few teaching points that most doctors need to see. Click Here to see the “Instructions for Your Doctor Afterwards” page.

When do I get my blood tested?

We give everybody a pre-printed order form to get your blood drawn to put the final exclamation point on this problem for you. Technically, we don’t really need to check calcium and PTH for the mast majority of our patients a few months after the operation because we know with essentially 100% accuracy that you are cured because we 1) evaluated all four glands, 2) removed the bad ones, 3) and measured your PTH in the recovery room showing a huge drop in the PTH (proving the remaining glands are dormant).

But checking the calcium and PTH at about 2 months is good practice and we want it done. And, it can give some insight for some of our patients who have significant osteoporosis and who may need to take more calcium than they currently are taking.

Should I fast for this blood test?

Nope, there is no reason to fast for the calcium and/or parathyroid hormone test. Just give them your arm and the order form.

Will I get a copy of my blood test?

Yup, we will email you a copy of the blood test, and at that time tell you if you need to increase (or decrease) your calcium intake. We will send a copy of these test results to all of your doctors as well.

When should I get my calcium and PTH checked?

We discuss this elsewhere in the Blue Post Operative Instructions section #3 of the app. We prefer your calcium and PTH be done about 6-8 weeks after the operation so the normal parathyroid glands are working perfectly and we can make “long-term” adjustments to your future calcium needs.  We have done this over 35,000 times and know that blood tests done within the first two weeks can be confusing at times and can cause more questions than answers.

blood test, fast, fasting, lab test, testing

When will bone pain go away?

When will bone pain go away?

Bone pain is common in patients with primary hyperparathyroidism. It is most common in older patients, and those with osteoporosis. The bone pain is usually in the hips, legs, back shoulders and arms, but hips and back are the most common. Of course there are reasons other than hyperparathyroidism that make people have bone pain, but if you have bone pain and a parathyroid tumor, there is a very high chance that the pain will be better, or often, completely gone.

Pain relief can be dramatic and fast

While most people with bone pain experience an immediate improvement following parathyroidectomy (usually within an hour of the operation). Often this is dramatic and life-changing.

A few patients notice that some pain returns within a week or two. The reason for this is not clear, but is likely a result of bone remodeling (rapid healing) that occurs after parathyroid surgery. Over time, this remodeling leads to improved bone density, but may cause discomfort. We recommend that you continue calcium and Vitamin D supplementation after your operation, and if you have not done so, start taking a daily magnesium supplement, which is important for calcium metabolism and bone health. Your bones will be much healthier with the parathyroid tumor gone – any bone pain that is associated with the parathyroid will be gone in days or weeks.

I still have joint pain

We occasionally get a call or email from a patient who is 2-3 months out from successful parathyroid surgery and they are concerned that their joints are still hurting.

Parathyroid tumors cause calcium to be removed from the bones. This causes osteoporosis (sometimes severe) and can cause bone pain. The bone pain is caused by exposure of nerve endings within the inside of the bone as the calcium is dissolved away by the excess parathyroid hormone.

Joints are cartilage, not bone

Joints on the other hand, are comprised of a cartilage surface of the bones. The cartilage is not affected by PTH hormone, so hyperparathyroidism is usually not associated with joint pain. More specifically, hip pain can be both bone and cartilage, so it can get better. Knee pain, however, is usually not caused by parathyroid problems or made better by parathyroid surgery.

Parathyroid related bone pain goes away quickly

Bone pain from parathyroid disease is usually an achy pain in the hips, backs, legs. arms and wrists. It usually does not affect the hands, fingers, knees, or ankles. Most commonly it is a dull achy pain in the back and hips, and this usually is gone within 30-60 minutes of the operation. This is often dramatic!  Occasionally bone pain takes a few months to get better, due to the healing of the bone.

Joint pain is usually not caused by hyperparathyroidism so if there is any improvement it occurs much slower and can take a few months. If the joint pain is still present after 2 months, then it is a cartilage problem and not related to parathyroid problems. So it likely won’t be getting any better.

Will calcium make me constipated?

Three reasons for constipation

There are three possible reasons for getting constipated after a parathyroid operation. The first and by far the most common cause for constipation is anesthesia. The anesthesia drugs that put you to sleep can also have an effect on the entire bowel, and this can take a few days to get better. Think of it as your bowel going to sleep and the “autonomic nervous system” of the bowel is slower to wake up than your brain. It is common for people to have problems going to the bathroom for several days following ANY operation because of the anesthesia. This isn’t just true for parathyroid surgery–it is all kinds of surgery. This will go away within a few days, but feel free to use any laxatives you want!

Decreased PTH levels means decreased bowel function

The second reason for constipation following parathyroid surgery is the change in parathyroid hormone levels following the operation. PTH has a dramatic effect on the bowel causing it to be more active in absorbing minerals such as calcium. A successful parathyroid operation means your PTH levels are low for a few days and this results in your bowel being quieter and slower than what you have been used to. When the normal glands wake up and start making the correct amount of PTH in 2-3 days, the constipation will get better.

Calcium can cause constipation

Unfortunately, the calcium pills can cause constipation in some people, but this is the LEAST common cause of constipation in our patients. We put our patients on Citracal calcium pills because this is the form of calcium that is least likely to cause constipation. So there is no other better form of calcium to take to help with constipation. Most people want to blame their constipation on the calcium pills, but this is usually not the cause. Usually its a combination of the first two reasons above.

What to do about it

There are some things you can do to combat constipation if you get it. First, please make sure you are drinking plenty of water–drink more than you normally would. Drink a lot of water!  Second, take a daily stool softener and a daily fiber supplement like Metamucil or Benefiber.  Third, eat a high fiber diet.  Fourth, if you are still experiencing moderate to severe constipation, you can use a mild laxative like Metamucil or something stronger like Mag Citrate and / or a fleets enema.  And YES, you can use any available product to help you go. So go to the store and do what you need to do. You can take over-the-counter laxatives or stool softeners to help get things moving.

While you’re at the store, we highly recommend patients take a daily Magnesium Oxide or Malate supplement of about 400mg at bedtime. This helps with many things like bone remodeling, muscle health, sleep aide, and can help with digestive health.

We recommend Citracal because it tends to be well tolerated and the type of calcium in it (calcium citrate) does not normally cause constipation, unlike other forms of calcium. Calcium carbonate, the most common calcium supplement (in TUMS, Oscal, Caltrate, etc) very frequently causes constipation when you take more than 2 per day. That’s why we tell you to get calcium citrate.  Do not switch to Oscal or Caltrate, or Tums thinking it will help–it will make the constipation worse.

Having loose stools?

Citracal can sometimes do the opposite – occasionally it causes loose stools or diarrhea but that is very uncommon which is why we recommend it. Some people get bloating or discomfort when taking lots of calcium the first week, but this is often not the calcium and may just be due to the changes in hormones that you are going through after removing the hormone-producing tumor. If you are having loose stools while taking Citracal, try taking a different form of calcium supplement, such as Oscal D  or Caltrate (calcium carbonate and Vitamin D).

Bottom line

You had an operation and anesthesia. Your body’s hormones are changing. All of these things are short lived and will go away. Drink lots of water and take whatever remedies you want. It will be gone in a few days!

Take calcium even if I had stones?

Kidney stones are common in hyperparathyroidism

About 25% of women with primary hyperparathyroidism will have kidney stones. The percentage is higher for men with a parathyroid tumor, with about 38% of men getting stones. In virtually every case, the kidney stones are made of calcium which came from your bones. This happens because the parathyroid hormone (PTH) causes a release of calcium from the bones and this excess calcium can build up in the kidneys and cause stones.

Won’t the calcium pills make this worse?

Nope, not at all. If you had kidney stones, it was because of the parathyroid tumor in almost all cases, not because you were eating too much calcium in your diet. When you are cured of the parathyroid disease and your calcium becomes normal because the parathyroid tumor(s) has been removed, then your kidney stone problem is gone (in almost all cases). Thus, you should still take your calcium to make your bones better. Your stones came from the tumor, and you don’t have that any more after the operation.

I have a cold/flu, should I cancel my surgery?

Nope!

Having a cold or some other “illness” is not a reason to cancel your parathyroid operation. Having parathyroid problems will effect your immune system and can actually increase your risk of getting colds or the flu.

Do not worry about this kind of stuff. If you are healthy enough to get here, you are healthy enough to have an operation. Do not cancel or delay your operation because you have a cold, or a bout of gout, or some other minor illness.

Do I stop NSAID, aspirin, ibuprofen, Tylenol before surgery?

Well, it depends…

Tylenol:  This has no effect. You can continue to take up to the day of surgery. No need to stop. We would be remiss, however, if we didn’t tell you that Tylenol is not very good at treating pain after the operation. Most people don’t need any pain pills after parathyroid surgery at our Center, but if you do, ibuprofen, Advil, Motrin are usually the best.

Aspirin: we have another page on Aspirin, go there. We prefer that you stop taking aspirin 5 days before surgery, and can re-start the day after surgery.

Ibuprofen, Advil, Motrin:  Just like Tylenol, you can keep taking this. No need to stop.

Aleve, naproxen, Naprosyn, Anaprox:  All of these drugs are the same, Aleve is just a smaller dose than the others and is available without a prescription. You should stop all of these drugs 5 days prior to surgery, just like aspirin. You can re-start using these drugs the evening of surgery.

Plavix: We have a separate page about Plavix. Click Here.

Can I wear makeup?

MakeUp

We understand that some women feel “naked” without their makeup. However, having surgery isn’t a glamour competition and most people come looking quite “ordinary”. Yes you can come to the hospital wearing makeup. You don’t have to come naked! However, be light on the makeup, and especially, no base or other kind of makeup on your neck.

Leave jewelry at home

Try not wear jewelry, earrings, bracelets, necklaces, or watches.  You can’t go into the operating room with any jewelry on. If you bring jewelry we will have you take if off and give it to your family or put it into a safe we have for you (we have a personal safe for every patient).  If you can’t get your wedding ring off, we can work around it. Same goes for some body piercings, we can work around it.

Nail Polish is OK

Some surgery centers require that their patients remove all their nail polish. We do not have that requirement. You can leave your nail polish on.

Bottom line

Our patients are the best looking people in the hospital!  However, try to remember that all of the hospital folks are dressed in scrubs and loose fitting clothes. Nobody looks very good at the hospital!  So save your beautiful red stilettos for your celebration dinner.

Will my GERD get better?

GERD is common in parathyroid patients

GERD (Gastro Esophageal Reflux Disease) is common in parathyroid patients because our bodies use calcium as a trigger for acid production in the stomach. In fact, 65% of our patients are on a GERD medicine, more than three times the rate of people who don’t have a parathyroid problem. The surgeons at the Norman Parathyroid Center published a large, prospective study in parathyroid patients with GERD and found that the GERD improved significantly or went away completely in about 82%.

When might it get better?

In this research study of 3000 patients, we found that these improvements in the symptoms of GERD happened between 2 weeks and 3 months, but typically around 1 month after the operation. For this reason, we recommend that if you are taking medicine for GERD (like Nexium or Prilosec) that you continue taking these medications for about 1 month after the operation and then start to taper it down to zero. Of course, you should discuss this with your doctors back home, especially the doctor who put you on these drugs.

But the bottom line is this, many people have GERD because of a parathyroid problem and many people will get partial or complete relief from their GERD within a few months of getting the parathyroid problem fixed. In our study of 3000 patients, about 62% were able to stop taking their GERD medicines completely within a few months of having their parathyroid tumor removed. Another 25% were able to significantly decrease the amount of GERD medicines they took, and about 13% of people didn’t think the parathyroid operation helped their GERD at all.

Footnote:  Surgical cure of primary hyperparathyroidism ameliorates gastroesophageal reflux (GERD) symptoms. Norman J, Politz D, Lopez J, Boone D, Stojadinovic A. World J Surg. 2015 Mar;39(3):706-12.

Read more about it:   blog.parathyroid.com/gerd-high-calcium/

When is my life going to change?

Soon!

Parathyroid surgery is life-changing for most people. The vast majority of people say that it is nothing short of a miracle. But when this changes is dependent upon 1) how long you have had a parathyroid tumor, 2) how severe your disease is, 3) what symptoms you have, and 4) other underlying diseases.

When will I feel the change?

People are different, and different symptoms go away at different times. We cover this in the blue “after your operation” section, so go there to read more, and to read about the Turtle and the Rabbit. Some people feel amazing within 2 hours of the operation. Most people feel the miracle happens between 5 and 7 days after the operation. Some people (the turtles) don’t feel much different for 1-2 months. But 95% of people say what happened to them, and the returning “joy of life” happens within a few days or weeks of surgery.

Do some people have no changes?

A parathyroid operation does not change the life of everybody. About 5% of people (that is one in twenty) people don’t have many changes and sometimes these folks get frustrated a month or two later when other people had a miracle and they did not. Most often, these are people who have LOTS of symptoms (they check nearly every symptom on the “symptoms” page of parathyroid,com.  Also, those that don’t get a miracle are typically people that have “mild” biochemical disease–that is, they have calcium levels that are only mildly elevated and PTH levels that are high normal. Do they have a parathyroid problem, almost certainly, but the parathyroid problem may be only a small part of the overall issue going on in their body. If these folks are still feeling the same a few months after the operation then the answer is that the parathyroid problem was NOT the cause of their symptoms. If this is you, you must avoid the temptation to say that the parathyroid problem isn’t fixed because the symptoms are still present. The answer is that the symptoms were not due to a parathyroid problem in the first place.

Nobody can tell who won’t get better.

We can almost always tell who is going to have a life-changing experience after getting their parathyroid problem fixed–it’s about 95% of the people we operate on. However, even after more than 34,000 parathyroid operations we have a hard time telling who ISN’T going to get amazing relief of their symptoms.  Sometimes we have a clue, and we tell these people before the operation that they are in the 80/20 category, meaning that they have about a 20% chance of undergoing no changes after the operation. If we tell you that you are in the 80/20 category, this means that our experience from looking at your lab values and your symptoms, and comparing them to many thousands of people that we have already treated, that you are in the category that your symptoms (and possibly even your lab tests) may not change after the operation. The “20” means that you have a 20% chance that this will happen to you.

Thyroid hormone shifts / weird symptoms

Sometimes people feel weird for a few days or even a week after surgery. This is not common–most people feel great!  But sometimes people will call the office and say they feel bad. They think they are having low calcium symptoms but they don’t have any tingling or the typical low-calcium symptoms (which very few people get!).

What is happening in most of these people is 1) they are still a little sick/weird from the anesthesia drugs, or 2) they are a little weird from changes in the parathyroid hormone levels (big changes in hormones occur after this operation), or 3) they are having a few symptoms from extra thyroid hormone being released from their thyroid gland. Most of the time it is a combination of the first two. Remember, the purpose of the parathyroid operation was to change the hormone levels in the blood, specifically parathyroid hormone. But these hormones are all tied together to some degree and this can make people feel weird for a few days. It will always get better as you get used to your new, healthy levels.

Fast heart rate, high blood pressure, feeling anxious

Parathyroid surgery requires your surgeon to move the thyroid from side to side to get to the parathyroid glands which are behind the thyroid. This can sometimes cause the thyroid to spit out a little extra thyroid hormone into your system for a few days. This can cause facial redness/flushing (first 48 hrs), headaches, feelings of anxiety and shakiness, mild periodic elevations in the heart rate and blood pressure, insomnia, loose stools, generalized fatigue, weakness, occasional dizzy spells, and hot/cold flashes.

This will resolve over the next few days and possibly as long as 10-14 days. Extra calcium should only be taken if you are having low calcium tingling and/or numbness. If there are any questions, call us, but know that this will pass in time. Feel free to treat the symptoms (such as Tylenol or ibuprophen for headaches) and stay hydrated.

Do I get the results of my biopsy?

Most people ask this question because they are trained to think “cancer” and want to know if the parathyroid tumor we remove is cancerous. The good news is that parathyroid cancer is extremely rare. We have removed over 55,000 parathyroid tumors and we have seen parathyroid cancer about 3-4 times. That is one in 12,000 — so please don’t ask if it is cancerous. It is not.

Its all about the hormone, not the biopsy

Parathyroid tumors don’t cause problems because they are cancerous, they cause problems because of the parathyroid hormone they produce. Thus this entire operation is based upon hormone levels (before the operation, during the operation, and after the operation for years to come).

Our surgeons take a very small “shave” biopsy (like the head of a pin) of the normal parathyroid glands to see if they are normal or abnormal, and to measure how much parathyroid hormone (PTH) they are producing. These small biopsies go to the pathologist who generates a report that simply says “parathyroid tissue identified”. This tiny biopsy helps make sure the glands have been identified, and they help make sure that normal glands are not removed like happens in most cases where the surgeon removes a gland so they can measure the hormone drop in the blood. Editorial comment: That is the dumbest thing in the world and surgeons who are doing this are hurting patients.

Thyroid nodules

Thyroid nodules are common! Most people have thyroid nodules, and within our patient population (average age 60), about 70 percent of our patients have one or more thyroid nodules. We evaluate EVERYBODY’S thyroid during their parathyroid operation (something most other surgeons in the world do not do, because they only operate to remove the one parathyroid that shows on a scan and they don’t check anything else). That’s why you are here at our center–we have the hood open to change the oil, and will will check the fan belts while we are there.

We remove thyroid growths and nodules in about 25% of the parathyroid operations we perform. These are always examined by the pathologists to examine for cancer. This biopsy process by the pathologists takes about 2-3 days to perform. Occasionally, this can take a week or even two if we need to have other specialists look at it.

Historically, only about 3% of the thyroid nodules or growths we remove have cancer in them—we error on the side of not leaving a cancer in you, thus over 95% of the nodules we remove are not cancerous. But it will help you avoid getting routine ultrasound scans on your neck every 6-12 months to see if the nodule grows. It can’t grow if we remove it! We do not want you to worry about any thyroid nodule we remove. We will call you if there is any bad or worrisome news. No news is good news!

What if my thyroid nodule is cancerous?

Did you know that in late 2016 the Norman Parathyroid Center recruited the number 1 thyroid cancer surgeon in the US to join our team? Dr Gary Clayman was the Chief of Surgical Oncology at MD Anderson for 17 years before coming to Tampa to open the Clayman Thyroid Cancer Center. We work side by side Dr Clayman and his team and if any of our patients need the world’s best thyroid surgeons, we have them right next door! Read more about Dr Clayman here: www.thyroidcancer.com/dr-gary-clayman-md. If you want to read more about thyroid nodules, go here: www.thyroidcancer.com/thyroid-nodule/.  If you want to know more about thyroid surgery, go to the front page of this great website: www.thyroidcancer.com

Bottom Line

Don’t worry about the pathology reports–more than 95% of our pathology reports are boring. If there is anything exciting in your report we will contact you, and your doctors will get a copy as well. If we do find a thyroid cancer during your parathyroid operation we will deal with it then, or develop a plan to have it addressed in the future. Remember, you came to our center because are the best in the world at this, and we have far more experience than any other doctors at these issues. It’s pretty safe to say we have seen every situation before and we know how to deal with virtually anything that can arise. That’s why you are here!

When can I get flu shot / vaccine?

Many of our patients get an annual flu shot. That is fine. The timing of a flu shot or flu vaccine will have no effect on your parathyroid surgery. You can have the shot anytime before or after your parathyroid operation at the Norman Parathyroid Center. It will have no bearing whatsoever on your outcome at surgery, or the effectiveness of the shot. Go for it!

Do you remove the entire parathyroid gland?

This is a question that is asked by one or two people per day, and it’s a pretty good question. We all have four parathyroid glands and when we get hyperparathyroidism one of the glands (or more than one sometimes) becomes a tumor. Actually in the vast majority of cases, the tumor grows out of the normal parathyroid gland, but in some cases the entire gland is big and there is no normal gland left.

In more than 99% of the cases, the tumor “on” the parathyroid gland cannot be saved and thus the entire gland is removed. Even if we could just remove the tumor and save the “normal” gland part, we wouldn’t want to because this gland has already declared itself as a bad gland and it could grow another tumor.

The simple answer is “yes”

Thus the simple answer is yes, in almost every case, the entire parathyroid gland is removed. God gave you four parathyroid glands and as it turns out, we can life a perfectly normal life with just one-half of one. You came to us with 4 glands, and you left with less than 4.

Exceptions to the rule

The exception to the rule is in people that have had previous parathyroid surgery somewhere else prior to coming to our Center (we do several of these a day!). In almost every case, one or more normal parathyroid glands have already been removed by the previous surgeon when they couldn’t find the tumor. Often, all three normal parathyroid glands have been removed prior to the patient coming to see us. So when we find their tumor (the only tumor they ever had usually), we try very hard to save some of the normal gland attached that that tumor because they have nothing left. Sometimes we can’t save the normal gland and we have to perform a parathyroid transplant and put some of the tumor into a muscle. You don’t want to live with zero parathyroid glands! Yes, this works just fine.

Will one of remaining glands go bad?

It depends on who did the operation

If you had surgery at the Norman Parathyroid Center (not everybody who uses this app has surgery with us) then there is almost zero chance you will get another parathyroid tumor later in life. We learned long ago that the only way to provide a “durable” cure of hyperparathyroidism that lasts people for decades (or the rest of their life!) is to examine and test all four parathyroid glands. So that is our routine operation–we check the other glands to see what they are up to.

Almost no other surgeons check all four glands

Finding all four parathyroid glands is extremely difficult and takes at least 2,000 parathyroid operations to be able to do it routinely. Problem is, nobody in the world (except us) does more than 100 parathyroid operations per year. Most Endocrine Surgeons that call themselves experts only do between 20 and 50 operations a year. And, they only try to find the bad gland, they don’t even try to find the other glands. That’s why 15% of our patients have had a failed operation somewhere else before they get here. The vast majority of surgeons don’t even try to find the other glands!  We think this is cheating the patients and these patients are at a much higher rate of having another parathyroid tumor (either immediately or later).

For our patients: Near zero chance to get another parathyroid tumor

We’ve performed well over 33,000 parathyroid operations and it is very rare for our patients to come back with another tumor even 20 years later. The reality is that it is extremely rare for any person to get parathyroid disease twice — IF YOUR SURGEON CHECKS ALL FOUR GLANDS DURING YOUR OPERATION.  If he/she does not, then AT LEAST 15-20% of you will need a second surgery within 20 years.  At least 10% of you will need a second surgery within 5 years.

Bottom line:

If you are our patient, it is very unlikely you will ever need our services again. We will miss you!  But if you do need us again, we are here for you!

What causes hyperparathyroidism?

Great question… but we don’t know!

This is a question that almost all patients or their family ask us. Unfortunately, we don’t know the cause of hyperparathyroidism. Parathyroid tumors develop in every country at the same rate throughout the world. Hyperparathyroidism is more common in women three times more commonly in men so we think there is something related to the fluctuating hormone levels in women that contribute, but obviously, men get this too.

Something in the environment?

Sometimes people will ask if there was something in their diet, or some environmental exposure that could have caused it. However, there has never been any component of diet or any kind of exposure to anything in the environment that has been linked to the development of parathyroid tumors

Radiation exposure causes parathyroid tumors

Radiation to the neck will often result in a parathyroid tumor (or tumors) 20 or more years later. Radiation was used back in the 50’s and 60’s to treat infected tonsils and to treat some cases of acne. Some of those patients get a parathyroid tumor many years later. At the Norman Parathyroid Center, we operate on about one of these patients per week.

Radioactive iodine ablation of the thyroid

Radioactive iodine is used to kill thyroid glands in people who have a large thyroid (called a goiter), or for people with Grave’s disease (overactive thyroid), or for people who have thyroid cancer. Most people who have radioactive iodine to kill the thyroid will get a parathyroid tumor about 15 years later. We operate on one or two of these patients per week.

Lithium treatments

Lithium is a drug that is sometimes used to treat depression. People taking lithium for more than 5 years will often develop a parathyroid problem. This is the only drug that has been linked to the development of hyperparathyroidism.

Bottom line

The bottom line is that we don’t know what causes parathyroid glands to develop into a tumor in over 95% of cases. It just happens. And just because it happened once, does not mean it is going to happen again. If your surgeon looks at all your glands, the chance of you getting parathyroid disease twice is very low… less than 1%

Is taking calcium for years dangerous?

About once every 2 weeks we get asked if taking calcium every day for years can be dangerous. This question typically stems from some reports back in 2012 that said patients with high blood calcium are at higher risk of heart attacks and other heart and blood vessel disease.  No kidding!  Of course we know this because that is what hyperparathyroidism does!

Unfortunately, the lay media doesn’t understand this very well and they concluded that taking daily calcium can be bad for your health. Well, it is more complex than that.  Important!  On this page of the app we are talking about taking calcium for YEARS after your parathyroid operation. We are not talking about the high doses of calcium you must take in the first 2 weeks after your operation. Now that you understand the context of this page, let’s look at what you should do for the many years after your parathyroid operation.

Patients with parathyroid problems are different.

Patients who had a parathyroid problem (hyperparathyroidism) can have different calcium requirements from “regular folks”  for many years after their parathyroid operation. Parathyroid patients typically have lost quite a bit of calcium from their bones. Of course we call this osteopenia, or osteoporosis (the second being just more advanced than the first). Therefore, patients who had a successful parathyroid operation should be taking calcium for a “long time” to replace the calcium that was lost.

How long is a “long time”?

How long you take calcium after your parathyroid operation depends on your bones, your age, and whether you are a man or woman. So there is not a single recommendation for all our patients. Women typically need to take calcium longer than men. Post-menopausal women typically need to take calcium longer than younger women. A “long time” can be 6 months for a healthy 40 year old man, or it can be for the rest of your life if you are a post-menopausal woman with very bad osteoporosis.

What do your bones look like?

One of the reasons we ask for your bone DEXA scan (osteoporosis scan) when you are becoming a patient of ours is because we want to see how much damage has been done to your bones–which can sometimes be a reflection on how long you have had the parathyroid problem. If you have bad osteoporosis you will need to take calcium for many years, and may need to take one of the osteoporosis medications too (i.e., Fosamax, Reclast, etc).

If your bones are not very bad and you are not post menopausal, then a typical recommendation would be to take 2 calcium pills per day and a multi-vitamin per day for a year or so after your operation, and then cut back to one calcium pill and one multi-vitamin per day.  If you are a man, and your bones are good, you can stop taking calcium in 6 months. If you are a man with osteoporosis, then you need the same as a post-menopausal woman until your bones are better.

Bottom line

The bottom line is that the data that says taking calcium every day is bad does not really apply to patients who had a parathyroid problem. However, there is no reason to take calcium (or anything else) that you don’t need. Let your bone density determine what you need. We do, however, recommend that all women over 40 take one calcium pill and one multi-vitamin every day.

We have other sections in this app that discuss which multivitamin to take (doesn’t really matter), and other pages on osteoporosis medications.

Have you gone to the app store and given this app a 5-Star Review?   Why not?

My friend needs THYROID surgery

Several people per day say to us: “Do you do thyroid surgery too?  I have a friend that needs thyroid surgery.” 

Of course, on this page we are talking about THYROID and not PARA-THYROID.

Well … Yes and No

The Norman Parathyroid Center is the best in the world because we do one thing only; we only do parathyroid surgery and have done more than the top 20 universities combined. However, many endocrinologists have asked us over the years to provide this level of expertise for THYROID also. They are tired of sending their patients to their local ENT surgeon for thyroid surgery and then having the patient lose their voice and not be able to talk because of damage to the vocal cord nerve. They got tired of having their thyroid cancer patients develop recurrent disease (the cancer comes back) several years after surgery because the surgeon didn’t get it all out.

Clayman Thyroid Center

In 2016 we were very fortunate to recruit America’s most experienced and respected thyroid surgeon to join us in Tampa. Dr Gary Clayman was the Chief of Surgery, the Director of Endocrine Surgery, and the Founder of the Thyroid Cancer Program at MD Anderson Hospital in Houston, Texas for 17 years. He literally “wrote the book” on thyroid cancer surgery.  We opened our sister center the Clayman Thyroid Center in September, 2016, and in just over 1 year it became the #1 thyroid cancer center in the U.S.

Thyroid and Parathyroid Institute at TGH

Dr Norman was instrumental in working with Tampa General Hospital (the home for NPC for over 20 years) to form the new Thyroid and Parathyroid Institute at TGH in 2016. The hospital started a $20MM building project in 2017 to house the new Institute which will be modeled after the tremendous success of NPC. The Clayman Thyroid Center and the Norman Parathyroid Center will be side-by-side in the new facilities which will take up the entire 6th floor of the building, housing 7 dedicated operating rooms, our own pathology and radiology services, recovery rooms and everything else we need.

Great news for patients with thyroid and parathyroid problems

The good news for the patients is that the expertise necessary to tackle any problem of the thyroid or parathyroid is located in one area. The most experienced thyroid surgeons are working hand-in-hand, side-by-side the world’s most experienced parathyroid surgeons.

So if your friend or family member needs thyroid surgery, now you know where the best in the world is located!

Click Here to go to the Clayman Thyroid Center website:  www.ThyroidCancer.com

Click Here to read more about Dr Gary Clayman: www.ThyroidCancer.com/Dr-Gary-Clayman-MD

Where do your patients come from?

The Norman Parathyroid Center operates on about 75 parathyroid patients per week, and they come from all over the world.

• About 92% live outside of the Tampa Bay area
• About 60% live outside of Florida
• About 4% are from Canada (more Canadians are operated on here than anywhere in Canada)
• About 5% are from Europe, the Middle East, Australia, etc.
• Check out the MAP link below to see locations

How do the patients get sent to you?

The majority of our patients are sent to us by their doctors. About 40% are sent by an endocrinologist. About 40% are sent by their PCP or cardiologist, or nephrologist.

About 20% of patients send themselves to see us. Many of this last group are fed up with how things are going. They are tired of getting scans and the doctors giving vitamin D to try to “fix” what they have come to understand is a freaking tumor in their neck.  About 35% of our patients have downloaded our CalciumPro app which helps them diagnose hyperparathyroidism because their doctors were getting it wrong.

#1 Parathyroid Center in Texas, and California, and … 

Did you know that more people in Texas are operated at the Norman Parathyroid Center than anywhere in Texas? This is also true for New York, Ohio, California, Georgia, Alabama, Pennsylvania, and about 20 other states. More people in Canada have their parathyroid operation in Tampa than anywhere in Canada.

Check out the map!

Check out our interactive map that shows where our patients came from. Some of our past patients are your neighbors!

Is parathyroid disease more common in women?

Yes. About 75% of patients with hyperparathyroidism are women.

Women get hyperparathyroidism 3 times more often than men, but men get it too! 

The average age is 61

For both males and females, the average age of patients being operated on for hyperparathyroidism is 61. But since most of our patients have had a parathyroid tumor for at least 5 years (sometimes much longer), then we can assume that the average age for developing a parathyroid tumor is about 55.

Every age can get a parathyroid tumor

Although the average age of a patient getting a parathyroid operation is 61, we operate on patients over 80 years of age virtually every day, and people over 90 about every week or two. We operate on teenagers about every 3 weeks, far more than any other institution in the world. We’ve operated on patients as young as 9 years old, and as old as 105. Interestingly, operating on our oldest patients is often the easiest as these patients do amazing after a quick surgery and are typically gone from the hospital in an hour or so.

Who to call in an Emergency?

Emergencies are extremely rare in our practice. We have sent well over 35,000 patients home within a few hours of their parathyroid operation. We have become very good at this one operation!  But if you need us, we are here and we have several ways to get hold of us.

A real emergency? Call the surgeon that operated on you.

If you think it is a real emergency, call one of our doctors. You will be given the personal cell phone numbers of all of the surgeons when you arrive at the hospital. Preferably call the one that called you the night of surgery. As a second choice, call one of the three surgeons that took care of you on your day of surgery.

Not sure it is a real emergency? Call our nurses.

During the day Monday-Friday, 9am-4pm you can call to speak with our nurses at the hospital (Anna will give you her direct number the day of surgery).

As a second choice, you can call our office at 813-972-0000—Monday-Friday, 9am-4pm to speak with our nurses (Carla and Kelly) in the office.

Bottom line:

Emergencies in our practice are extremely rare, less than 1 in 1500 patients. But we ALWAYS have multiple surgeons available to you. If you need us, we are only a phone call away.

Are metal clips used in my operation?

We use very small titanium surgical clips to control blood vessels during the operation. These types of clips are very common and are used in most operations in any part of the body. Your body does not react to the clips - you cannot have an allergic reaction to them. Also, these clips do not affect MRI scans - all of these clips are MRI-safe.