Parathyroid Gland and Calcium after Total Thyroid Surgery

Introduction

This leaflet has been designed to give you advice about the effects of Total Thyroid Surgery (removal of your thyroid gland) on your Parathyroid Glands and Calcium levels.

Parathyroid Glands

The Parathyroid Glands are 4 small glands located behind (or sometimes inside) the Thyroid Gland at the bottom of your neck.

Each Parathyroid Gland has a very rich blood supply. They regulate the calcium levels in your body. Calcium is an important mineral needed for bone strength, controlling heart rate, managing hormone levels, blood clotting and sending/receiving nerve signals around the body.

Although these Parathyroid Glands are located next to (and sometimes inside) the Thyroid Gland, they have no related function.

The Thyroid Gland controls the body’s metabolism and has no effect on Calcium levels. The Parathyroid Glands control Calcium levels and have no effect on metabolism.

Calcium Regulation

As blood flows through the Parathyroid Glands, the Glands detect the amount of Calcium and react by making more or less Parathyroid Hormone (PTH).

PTH acts in a number of places such as the kidneys, bone and gastrointestinal tract to increase the amount of Calcium in the blood.

If the Calcium level in the blood is too high, the Parathyroid Glands make less PTH (or stop making it altogether), allowing Calcium levels to decrease. This repeats itself, balancing Calcium and PTH levels.

PTH is also involved in increasing Vitamin D levels. The body needs Vitamin D to absorb calcium.

Parathyroid Glands following Surgery

Your surgeon will make every effort to preserve your Parathyroid Glands during your surgery. But even in the best of hands their blood supply may be affected.

It may also be necessary to have one or more Parathyroid Glands removed completely. This can result in low Calcium levels which can be temporary or permanent.

Fortunately, you do not need all four Parathyroid Glands to maintain your calcium levels.

It can take up to several months for the remaining Parathyroid Glands to be able to independently control your Calcium balance again.

Blood Tests

Routine blood tests are taken the morning after your surgery. This is to check your Calcium levels. You may also require a PTH check.

If these levels are low, you may be prescribed supplements. Low Calcium is the most common cause of delayed discharge from hospital following thyroid surgery.

Low Calcium is managed by prescribing a Calcium supplement. If your Vitamin D levels are low, you may also be prescribed a Vitamin D3 supplement (Cholecalciferol).

If you are discharged home with a supplement, arrangements will be made for your bloods to be checked and your doses changed if needed.

Your GP may be asked to assist with blood taking, or you may return to hospital for this.

Parathyroid Glands usually recover their function within 6-8 weeks.

Symptoms of High and Low Calcium

• Low Calcium – Tingling in your hands, muscle spasms, cramps or numbness.

• High Calcium – Loss of appetite, loss of weight, feeling tired, feeling sick (nausea), feeling thirsty, sweating, a metallic taste in your mouth or a need to pass urine (wee) more often.

If you experience any of these symptoms you must let the specialist team know as soon as possible.

Calcium Supplements

If you are prescribed a calcium supplement the dose will be decided by your blood tests. It is important that you take your calcium supplements as prescribed if they are required.     

If you are taking Levothyroxine, your Calcium supplements should be taken 4 hours apart from this.

Possible side effects include:

• Constipation.
• Diarrhoea.
• Pain in the stomach area.
• Excess gas in the stomach and intestines (flatulence).
• Nausea.
• Indigestion.

For more information, please read the information leaflet within your medication box.

You can also discuss this with your doctor or pharmacist.

Vitamin D Supplementation

Because Vitamin D and Calcium levels are closely linked you may be prescribed a number of medications to support and supplement your vitamin D levels which will also help keep your Calcium in range.

This may include a medication called Alfacalcidol and a medication called Colecalciferol. These are both types of Vitamin D and can be used together or separately depending on the results of your blood tests.

Although Vitamin D can be bought over the counter, you should only do this if you are advised to by your medical professional as the strength and type of Vitamin D in these tablets can vary.

Both Alfracalcidol and Colecalciferol are generally well tolerated and have few side effects.

Alfacalcidol can occasionally cause skin rashes, itchiness and dizziness.

A full list of side effects is contained within the manufacturer’s information leaflet supplied with your medicine.

Please speak with your doctor or pharmacist if any of these continue or become troublesome.

It is also important to note that some adverse effects during treatment may be as a result of high, or low, Calcium levels.

It is important to be aware of the signs and symptoms of high or low Calcium (as discussed earlier in the leaflet).   

Contact Numbers

University Hospital of North Tees

Thyroid Nurse Specialist

Telephone: 01642 624627
Please leave a voicemail and you will receive a reply, although this might not be on the same day due to availability.

Surgical Secretaries Telephone: 01642 383292
Monday to Friday, 9:00 am to 4:00 pm

Targeted Lung Health Check Navigator Telephone: 01642 624963
Monday to Friday, 8:00 am to 4:00 pm

References

• The BAETS is the representative body of British Surgeons who have a specialist interest in surgery of the endocrine glands (thyroid, parathyroid and adrenal).
  www.baets.org.uk

• The British Thyroid Foundation works with patients and medical professionals to inform and support people of all ages living with thyroid disorders.The British Thyroid Foundation (BTF) (btf-thyroid.org)

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Comments, concerns, compliments or complaints

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