Canberra Endocrine & General Surgery

Diagnosis and Preoperative Evaluation
 
Before surgery is considered, a detailed workup is performed by Dr Hazel Serrao-Brown or at the request of your GP. This includes:
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• Blood tests: To assess calcium, PTH, and vitamin D levels.

• Bone density scans: To evaluate for osteoporosis.

• 24-hour urine calcium: To rule out other causes of elevated calcium.

• Imaging studies: Such as sestamibi scans, ultrasound, or 4D CT scans, to localise the overactive gland(s).

 
Not all parathyroid abnormalities are visible on imaging, so a negative scan does not exclude the need for surgery.

Intraoperative Monitoring

During surgery, intraoperative PTH monitoring may be used. This involves checking PTH levels before and after gland removal. A rapid drop in PTH indicates successful removal of the hyperfunctioning gland.​​

Risks and Complications
 
Parathyroid surgery is generally safe and effective. However, as with any surgery, potential risks exist:
 

• Voice changes or hoarseness: Due to injury to the recurrent laryngeal nerve.

• Low calcium levels (hypocalcaemia): Especially when multiple glands are removed.

• Neck haematoma or bleeding: Rare but potentially serious.

• Infection: Rare in neck surgery.

• Persistent or recurrent hyperparathyroidism: If the abnormal gland is not found or new disease develops.

Expected Post-Operative Symptoms (Normal)

These are common and typically improve within days to weeks:
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• Mild neck pain or stiffness

• Bruising or swelling around the incision

• Sore throat or hoarseness from the breathing tube

• Fatigue – common while your body adjusts, especially if starting thyroid hormone replacement

• Mild difficulty swallowing solids or feeling of “tightness” in the neck

 
These symptoms should gradually improve. If they worsen or persist beyond 1–2 weeks, notify Dr Hazel Serrao-Brown.

Surgical Procedure
 
Depending on diagnostic results and individual patient factors, Dr Hazel Serrao-Brown may recommend the following surgical procedures:
 
Minimally Invasive Parathyroidectomy (MIP)
This is the most common approach when imaging pinpoints a single abnormal gland. A small incision is made in the neck, and the affected gland is removed. Benefits include a shorter procedure, faster recovery, and minimal scarring.
 
Bilateral Neck Exploration
If the abnormal gland cannot be clearly located preoperatively, or if more than one gland appears abnormal, bilateral exploration is performed. All four parathyroid glands are identified and assessed, and any abnormal ones are removed.
 
Subtotal or Total Parathyroidectomy
In patients with hyperplasia or tertiary hyperparathyroidism, 3.5 glands may be removed (subtotal), or all four removed with auto transplantation of part of one gland into the forearm (total parathyroidectomy with auto transplantation).

Recovery and Aftercare
 
Most patients return home the same day or within 24 hours. Recovery is generally quick, and discomfort is minimal. Patients are monitored for calcium levels in the days and weeks after surgery.
 
You may be prescribed:

• Calcium supplements

• Vitamin D

• Regular follow-up blood tests

If symptoms of low calcium occur—such as tingling in the fingers or around the mouth, cramping, or muscle spasms—medical attention should be sought promptly.

When to Seek Medical Help Post-Surgery

Contact Dr Hazel Serrao-Brown and her surgical rooms if you experience the following symptoms:
 

• Severe or worsening neck swelling

• Difficulty breathing or swallowing

• Persistent voice changes

• Tingling or cramping that doesn’t resolve with supplements

• High fever or signs of infection at the surgical site