You will wake up in recovery room and stay for usually half to one hour, until you are awake, comfortable and heart rate, blood pressure and breathing are satisfactory.
You will initially only be allowed mouth wash or rinse and then later sips of fluid and then food. There is a very small chance of bleeding in the first few hours and we prefer to keep your stomach relatively empty initially in case you need to go back to operating theatre.
In the unlikely event of signifcant bleeding, the neck will become obviously more swollen and it will be increasingly uncomfortable. Notify your nurse if you are worried and they are not already aware. You may have to urgently return to theatre to fix it. In very uncommon cases the stitches may be removed prior to going to theatre to release the pressure immediately.
You may get up and move around when you feel like it and cough if needed. However, avoid unnecessary exercise or straining.
You will have blood tests in the evening after surgery and again the next morning to confirm that you are cured and to help plan the need for, and dose of calcium and vitamin D medication to take after discharge from hospital.
Many people will advise you should sleep on your back and with your head elevated after neck surgery. We don’t believe it is helpful, so you may sleep with the bed flat and In a comfortable position for you.
You may have numb ears or shoulders initially and it may last 24 hours or so. That is from local anaesthetic and will wear off.
For most patients, there is only a very remote risk of blood clots in the legs or lungs after parathyroid surgery (Deep Vein Thrombosis, Pulmonary Embolism, Economy Class Syndrome). To reduce the risk further, we use stockings, calf compression devices and early mobility rather than injections. Injections of blood thinners increase the risk of bleeding inside the neck. Some patients at particularly high risk will have a specific plan made for use of injected blood thinners.
You will almost always have a subcuticular suture– buried dissolving stitch. This will literally dissolve under the skin after a couple of weeks and doesn’t need to be removed. The wound will be coved by tape such as Steristrips to help it to heal. Usually this will also be covered in surgical glue, similar to superglue. The Steristrip is made of paper and it may get wet but will dry off, and if it is glued, it will usually maintain its stickiness for 2 weeks or so.
Keep the wound fairly dry for 24 hours after surgery. You can wash your body if you have a shower hose or bath. Use a face washer to minimise wetting the wound. If the tape gets a bit wet, pat it dry. After this period, you can shower freely and pat the tape dry afterwards.
After 10 days or more, When the tape becomes loose, dirty or falls off, you may remove it completely and wash and dry. For best cosmetic results we usually recommend that you replace the initial steristrip with a new steristrip, micropore or other sticking surgical tape. You can then change the tape once to twice per week and keep it taped for 2 to 3 months. After 3 or more weeks, when changing the tape, you may gently massage into the scar, bio-oil, Vitamin E cream, Silicone scar gel, or other product from the chemist. Then dry off and replace tape.
When you go home you can do normal light activities around the house. You may go out if you feel like it. We recommend you don’t drive until you are freely able to turn your head and are not taking any stronger pain killers- usually at least 3 days to be cautious.
Keep physical activity limited to those which are light and non- straining / strenuous. There is a small risk of bleeding with straining, particularly in the first couple of weeks after surgery. For more extreme physical activity such as weights at gym, sports like soccer, netball, AFL, we recommend taking a break for six weeks. (even at three weeks post-op, one patient did a “pump” gym class and had sufficient bleeding to require re-operation.)
We don’t recommend you plan any flights to go on holidays within 6 weeks after surgery. You will still be recovering to some extent and your activities should be restricted in any case.
For your particular circumstances such as need to return home after surgery we recommend you discuss any plan to fly with your surgeon.
Infection is uncommon, but indicated by increasing swelling, redness and pain. You will need to get in touch with your surgeon- often photographs sent by phone can be helpful. It is uncommon, but possible to need antibiotics or surgery.
Voice. Generally, it will be obvious that your voice is going to be fine. In some patients, and depending on the extent of surgery, it is normal that your voice will tend to be a little croaky, easily fatiguable and may crack or disappear intermittently in the early days after surgery.
Swallowing
In most cases there will be normal swallowing with minimal discomfort, but you may feel tightness, restriction, difficulty swallowing- especially tablets or toast. Sometimes there may be a little more pain either from the surgery or from placement of the breathing tube.
Cough and phlegm. It is common to feel some irritation in the trachea (windpipe) and increased sense of, or production of phlegm or sputum. Except for patients with significant pre-existing bronchitis or COPD , chest infectionis unlikeluy.
Post- Operative review
You will usually have blood tests about 7-10 days after surgery and then a phone review. You may have in-person review if you prefer. Most patients will subsequently have another test in 6 months followed by another phone review.
When surgery has involved all Parathyroid glands or when there has been concurrent thyroid surgery, and in some other cases, you may need much more frequent initial blood tests and advice over the phone regarding calcium and Vitamin D dosage.
