Re-operative Parathyroid Surgery
Most experts consider a patient cured of parathyroid disease if they have a normal calcium level at 6 months after an operation. Of note, the PTH level is also usually normal, but in certain cases can remain high for a year or so after the operation. Although the cure rate after parathyroid surgery by an experienced parathyroid surgeon is approximately 95 to 98%, even in the best of hands, some patients will not be cured after the first operation. Additional (i.e. re-operative) surgery may be needed if the patient has either persistent disease (i.e. the calcium level is never normal after the first operation) or recurrent disease (i.e. the calcium level is normal for 6 months after the first operation but is then high again after that). Fortunately, for the small group of patients who need additional surgery, the cure rate after the second operation is close to 98%.
Every operation creates scar tissue which causes everything to stick together, making any additional operation in the area more difficult. The scar tissue can make finding important structures like the recurrent nerves (i.e. nerves that control your voice) and parathyroid glands very hard. Essentially, it's like pouring concrete into the area and then having to chip through the concrete to get at the important structures. For this reason, it is critical to do as focused of an operation as possible. Most experts will order a few localizing tests to find exactly where the diseased parathyroid gland is so that they can go directly after that parathyroid without having to explore the entire neck. See Localization ». In addition, most surgeons will check to see that the vocal cords are working normally with a test called a fiberoptic laryngoscopy because the nerve that controls them (i.e. the recurrent laryngeal nerves) can be injured in the first operation. In order to help in their evaluation and to plan their operation, patients should bring copies of their operative and pathology report from the first operation as well as any laboratory results and radiology images that they had both before and after the first operation.
Re-operative parathyroid surgery is more complex and riskier than first time surgery and should be done by a surgeon who has significant experience with re-operative surgery at a center that can provide special tools such as cryopreservation. See Cryopreservation ». New York Parathyroid Center surgeons all have extensive expertise with re-operative parathyroid surgery.