I recently ran into another patient who suffered terribly as a result of their doctor forgetting to tell them an important detail about their surgery. In this case, it was a thyroid cancer patient who underwent total thyroidectomy and ended up in the hospital mere days later - alone.
Do you think she was frightened when her pulse raced, her BP went
high as a kite and her limbs began to spasm uncontrollably? You bet!
The sad thing is, she should have known this might happen to her and
she didn't. It resulted in a frantic call and an ambulance ride.
Unfortunately for thyroid cancer patients, removal of this small
gland in your neck is not as easy as it might seem. Not only does the
thyroid tend to be a bit touchy (see Thyroid Storm) but it normally
spends its life in an intimate embrace with a group of tiny rice-like
glands called the Parathyroids which, when disturbed can get rather
angry and a bit depressed.
Your parathyroids are tiny rice sized little glands found between
your thyroid and your esophagus. Their purpose... to control the
calcium in your body.
Think this sounds like an easy job? It's not. In fact, without our
parathyroid glands doing their busy work *just right* we would die.
In the case of thyroidectomy, not only does the patient need to be
aware of the possibility of a thyroid storm during or shortly after
surgery, but they should be told about the parathyroid's propensity for
drama when disturbed or damaged.
A skilled head and neck surgeon will carefully handle the thyroid in
effort to keep the gland from dumping excessive hormone into the
patient's system, but he/she will also handle it very carefully because
he/she doesn't want the tiny parathyroid glands right beneath the
thyroid to be damaged. When these glands suffer injury, they tend to
stop functioning. This is called hypoparathyroidism and it is a fairly
rare condition because we usually the surgeon working on a patient is
skilled enough to avoid damaging the parathyroids. When this injury
occurs however, a serious calcium deficiency will result in hours or
What about blood calcium?
Calcium and phosphorous work together in balance. When one is low, the other has a tendency to be high.
Calcium serves many functions in the human body including being
responsible for: 1) electrical stimulation to our nervous system 2)
electrical stimulation of muscles (including the heart) 3) bone
strength. Blood calcium also helps in influencing the clotting process
in our blood and our mood and sense of well being.
The symptom of hypoparathyroidism is low calcium. Yes, the PTH
(parathyroid hormone) is also low, but the only function of PTH is to
control calcium, so this only results in aberrant calcium levels and
associated symptoms. Symptoms can range from very mild, to life
threatening and include:
++ tingling around the mouth and in the hands
++ muscle cramps (tetany)
This condition is rare, because most surgeons become skilled in the
removal of thyroid tissue before they begin operating alone on
patients. In some cases the surgeon is not as skilled as he should be
and these glands are accidentally removed or damaged. Sometimes the
surgeon knows this has happened... sometimes he doesn't. Either way, a
skilled surgeon is extremely unlikely to have a patient with
hypoparathyroidism unless he has made a mistake.
There are side effects and contraindications to every surgery. Every
surgery carries with it the risk that something bad can happen to you.
Hypoparathyroidism is almost always preventable. That said, every
doctor should tell every patient before every surgery that
hypoparathyroidism is a possible outcome. They should also be told the
treatment for it: A calcium supplement.
If you suspect that you or someone you know may have
hypoparathyroidism, seek immediate medical attention. Try to keep the
patient calm and inactive. If you choose to call ambulance personnel,
tell them your patient has had a thyroidectomy and what his/her symptoms
are so the ambulance crew can be prepared. This gives them the
opportunity to talk to each other and to a doctor if they have access to
one in preparation for their visit. In the meantime, talk to the
patient and take a medical history in writing. What medicines do they
take and how much as well as when? When did they last eat? Who are
their doctors? What medical conditions do they have? Allergies? Be
specific. Doing this is very helpful to the ambulance personnel who
will try to help you, but it will also keep the patient's mind off their
spasms etc. If the patient has calcium tablets nearby, they might wish
to try to take one in case it may help. However, doing this may alter
blood levels leading to a delayed diagnosis by physicians.
In this article,
it's estimated that 60% of physicians never tell their patients that
their parathyroid glands may be injured or removed accidentally during
surgery and hypoparathyrodism may result. It also notes that during
their study, the odds that a patient may end up with hypoparathyroidism
was almost always dependent upon the number of surgeries the physician
performed on a regular basis. It also notes that when questioned,
physician overestimated the number of surgeries they performed twice
over! Moreover, 61% of patients reported that their surgeon never told
them the reason for their hypoparathyroidism was a mistaken removal of
their parathyroid glands!
For more information on parathyroidism, see the Hypoparathyroidism Association Inc.
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