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Parathyroid Surgery

Experience and Excellence in Parathyroid Surgery

Dr. John Abikhaled is a highly skilled surgeon in Austin who specializes in parathyroid surgery. He is committed to providing the most advanced and minimally invasive techniques available, which can help you recover faster and get back to your daily routine sooner. Dr. Abikhaled’s extensive experience enables him to tailor his approach to your unique needs, ensuring that you receive the best possible care.

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Common Questions about the Parathyroid Gland

What are Parathyroid Glands?

Parathyroid glands are tiny, rice-grain sized glands located in the front of your neck. The name is a bit confusing, so it is important to understand that these glands are different from the thyroid gland.  Most people have 4 parathyroid glands located near the thyroid (thus the name “para”thyroid). They function to regulate your body’s calcium metabolism.  

What is Hyperparathyroidism?

Hyperparathyroidism is a condition in which one or more of your parathyroid glands becomes enlarged and overactive. Most often, one gland is overactive and the other three are normal, but it is possible to have overactivity of 2, 3 or even all 4 parathyroid glands.


An overactive parathyroid gland releases too much parathyroid hormone (known as PTH).  This causes an imbalance of your body’s calcium metabolism.  There are a variety of problems this can cause:


  • Elevated blood calcium levels

  • Loss of calcium from your bones, leading to osteopenia or osteoporosis, and increasing risk for fractures

  • Bone pain, especially in the long bones of the arms and legs

  • Kidney stones due to excessive calcium in the urine

  • Fatigue

  • “Brain-fog” or trouble with mental focus

  • Mood impairment or depression

  • Gastrointestinal conditions such as heartburn, constipation, and abdominal pain


Symptoms can be very mild at first but over time the consequences can become more severe.  Long term loss of bone density and risk of fractures is one of the most common major problems.

Parathyroid Gland Evaluation

Blood Tests

Hyperparathyroidism is diagnosed by blood tests.  Typically, it is first identified by a high calcium level seen on a routine blood panel.  The parathyroid hormone (PTH) level is then also tested, and if it is too high for the corresponding calcium level, hyperparathyroidism is usually confirmed.


Imaging studies are also performed to help identify the location of the abnormal gland before surgery.  It is important to understand that normal parathyroid glands are too small to be seen on imaging studies, and sometimes even the abnormal gland cannot be seen. 

Parathyroid Surgery

Surgery to remove the abnormal parathyroid gland (or glands) is the only effective long-term treatment for hyperparathyroidism.  The surgery is done in the operating room, under anesthesia.  Most patients can return home the same day. The operation is done through a small (approximately 1 inch) incision on the front of the neck and takes about 1-1 ½ hours. 


During the surgery, Dr. Abikhaled will look for the abnormal parathyroid gland and remove it. Because parathyroid glands, even abnormal ones, can be small and difficult to find, we use special tools that are quite helpful during surgery:

Radio Guided Surgery

Because abnormal parathyroid tissue will retain a radioactive molecule called sestamibi more avidly than surrounding tissues, radio-guided surgery can help identify an abnormal parathyroid gland.  An intravenous injection of sestamibi is given on arrival to the hospital before surgery.  In the operating room, a probe is used to detect the location of the molecule and guide the surgery.

Intraoperative PTH Testing

Parathyroid hormone has a very short half-life in your blood.  Because of this, once an abnormal parathyroid gland is removed, your PTH level will drop significantly within just a few minutes.  We draw a baseline PTH level before surgery, and then draw a new PTH level about 10 minutes after removing the abnormal gland. A decrease in PTH level of more than 50% indicates a successful operation.


While most patients with hyperparathyroidism have a single abnormal parathyroid gland, some patients may have more than one abnormal gland. Because of this, we also look for the other glands while we're waiting for the PTH result from the lab.  If other enlarged parathyroid glands are encountered, these may be removed as well.

Nerve Monitoring

One of the risks of parathyroid surgery is injury to the nerves that make the vocal cords move.  This can result in hoarseness or a weak voice.  We use nerve monitoring to minimize this risk.  Sensors on the breathing tube used for anesthesia are in contact with the vocal cords. If a nerve is stimulated during surgery, the vocal cord is activated, and the sensor produces an audible signal. This helps protect the nerves from injury.

Recovery from Parathyroid Surgery 

Recovery from parathyroid surgery is usually not very difficult.  Here are the most important things to know about your recovery:


  • When you get home from the hospital, you will want to rest for a while, but then it is important to get up and around, and to walk.  You should also walk the day following surgery and gradually increase your activity as tolerated. There is no reason to stay in bed.  You should take it easy however, and not engage in very strenuous activity for 2 weeks.

  • Your incision will be sealed with skin glue, which will peel off after a couple weeks. The sutures are buried under the skin and will dissolve. There will be no bandage to change.


  • You may eat & drink whatever is comfortable for you after surgery. Cool liquids, throat lozenges and voice rest can be helpful as needed.

  • You may shower beginning the day after surgery. You should not immerse the incision under water for 2 weeks.  After 2 weeks you can swim, etc.

  • You may have a sore throat and mild temporary hoarseness after surgery.

  • You should apply ice packs to your incision for 20 or 30 minutes at a time, several times the day of surgery and for 2 days after surgery. This keeps the swelling and soreness down.

  • You may only need over the counter pain meds like Tylenol (acetaminophen) and Advil (ibuprofen). You can take two regular strength Tylenols (325 mg each) and two Advils (200 mg each) together about every 8 hours.  

  • A prescription pain medication is usually also prescribed, but most people need little or none.

Low Calcium Levels after Surgery

Some patients experience temporary low calcium levels after surgery.  

  • After the overactive parathyroid gland is removed, the calcium level will begin to fall.  The normal glands have been suppressed by the overactive gland, and it can take them a few days to “wake up.” As a result, you may experience symptoms from the low calcium levels.  

  • Symptoms of low calcium include a numb or tingling feeling around your lips, on your face, or in your hands or feet.  Symptoms can also include muscle cramps or spasms, especially in the hands or feet, or twitches in the muscles of your face.

  • This low calcium level is easily treated by taking a calcium supplement such as Citracal Maximum Plus. This supplement contains calcium citrate and vitamin D, which helps your body absorb the calcium.  Please have a bottle handy after surgery. If you develop symptoms, you should take 2 tablets. The symptoms will resolve after 20-30 minutes. You will need to continue taking the supplement about 3-4 times a day until the normal parathyroid glands “wake up.” Please call the office and let us know if you develop symptoms of low calcium.

Follow-up After Surgery

  • We'll want to follow-up about 2 weeks after surgery. Please call to make an appointment. 

  • Any parathyroid glands that Dr. Abikhaled removes during surgery are sent to the lab for analysis.  He will have that result for you at your post-op visit.  We almost never expect the results to show cancer, as parathyroid cancer is extremely rare.

  • You will also continue to have ongoing visits with your endocrinologist after surgery. Please call their office after surgery to make an appointment with them. They will continue to monitor your calcium levels. It is rare, but occasionally patients will develop another abnormal gland in the future, sometimes years after their surgery, and a repeat operation could be necessary.

Risks of Parathyroid Surgery

Any surgery has risks, and there can be complications. Fortunately, complications are quite uncommon. Risks include, but are not limited to:

  • Bleeding

  • Infection

  • Complications related to anesthesia

  • Inability to find the abnormal gland

  • The need to perform more extensive surgery or parathyroid gland removal

  • Recurrent hyperparathyroidism (high calcium levels)

  • Permanent hypoparathyroidism (low calcium levels)

  • Injury to the recurrent laryngeal nerves which can cause vocal cord malfunction and hoarseness

  • Injury to the external branch of the superior laryngeal nerves which can cause voice changes

  • Other very rare complications including injury to other nerves or structures (such as vagus nerves, sympathetic nerves, trachea, larynx, esophagus, carotid artery, jugular vein), or death.

You should call the office if you experience increasing swelling at the incision site (some swelling is expected), severe pain, bleeding, signs of infection, a temperature over 100.4 degrees fahrenheit. You should also call if you develop symptoms of low calcium that do not respond to taking Tums. Symptoms of low calcium include numbness or tingling around the lips or in the extremities, or muscle cramps.


Dr. John Abikhaled removed 2 of my parathyroids a month ago. I was nervous. He explained the procedure very well and I felt like I was in very capable and experienced hands. After surgery he let me know how things went and what all he did during surgery.
Other than a sore throat, I only needed 2 pain pills during my recovery. 3 weeks later, he peeled off my superglue-like bandage to reveal the excellent job he did of almost no noticeable incision!!! I was shocked! This man did an amazing job! I would highly recommend him to my best friends!!

- PAM m.


Dr. John Abikhaled is a highly skilled surgeon based in Austin, Texas, who specializes in parathyroid surgery. He is dedicated to providing his patients with the most advanced and minimally invasive techniques available, which can help you recover faster and return to your daily routine sooner.

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