Froedtert & the Medical College of Wisconsin Endocrine Surgery – Before and After Parathyroid Surgery

Before Surgery

Before Your Clinic Visit: Before you see the surgeon, you may need to undergo a series of tests to evaluate your parathyroid glands. Testing may include an ultrasound, a sestamibi scan and/or a CT scan. These tests provide useful information to the surgeon about your parathyroid glands. You will also have routine blood work. Depending on your blood work results, some people may need to take vitamin D before surgery. Before Surgery: Prior to having surgery, a series of general screening tests are done to make sure you are healthy for surgery. These are often conducted 1-2 weeks before the operation and may include blood work as well as a thorough history and physical exam. Depending on your history, you may also need an EKG, chest x-ray, and/or stress test. These tests evaluate your heart and lung function. They do not require a hospital stay. Depending on your age and health, you may see a high-risk anesthesiologist, your primary care doctor or the surgeon for these tests.

Prior to surgery, you may also meet with an endocrine nurse practitioner who will educate you about the operation and make sure all the appropriate testing has been completed.

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Medication Guidelines

PLEASE ASK your doctor or surgeon BEFORE stopping or changing any of your medications.

Medication Guidelines Prior to Surgery: Certain medications may need to be stopped before surgery. Please consult your surgeon or primary care physician before stopping any of your prescribed medications.

Cardiac medications (blood pressure medications): DO NOT take on the day of surgery:

• Benazepril (Lotensin)
• Bumetanide (Bumex)
• Candesartan (Atacand)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Eprosartan (Teveten)
• Fosinopril (Monopril)
• Furosemide (Lasix)
• Hydrochlorothiazide (HCTZ)
• Iosartan (Cozaar, Hyzaar)
• Irbesartan (Avapro)
• Lisinopril (Prinivil, Zestril)
• Metolazone (Zaroxolyn)
• Olmesartan (Benicar)
• Perindopril (Aceon)
• Quinapril (Accupril)
• Ramipril (Altace)
• Spironolactone (Aldactone)
• Telmisartan (Micardis)
• Valsartan (Diovan)

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Blood thinners: Please make sure you have discussed this with your physician or surgeon before stopping these medications.

• Aspirin – Stop taking 7 days before surgery
• Coumadin – Stop taking 5 days before surgery
• Heparin – Must be held for 12 hours prior to surgery
• Antiplatelet agents (Plavix, clopidogrel, ticlopidine) – Please follow your surgeon or cardiologist’s recommendations.

Diabetes medications: Insulin – Patient with insulin pumps:

• Continue your basal rate ONLY

Patients without insulin pumps: On the morning of surgery:

• Hold short acting insulin
• Pre-mixed insulin (eg. 70/30): give 1/3 of usual dose
• Lantus: give usual dose

Oral diabetic medications: do not take the morning of surgery

• Metformin
• Glyburide
• Glipizide

Other prescription medications:

• MAO inhibitors – do not take the day of surgery
• Premarin – do not take on the day of surgery
• Viagra or similar drugs – do not take 24 hours before surgery

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Over-the-counter medications:

• Aspirin – stop taking 7 days before surgery
• NSAIDS (ibuprofen, Aleve, naproxen, Celebrex) – stop taking 7 days before surgery
• Iron – do not take on the day of surgery
• Herbal supplements and Vitamin E-containing multivitamins – stop taking 7 days prior to surgery

Day of Surgery

The Day Surgery department will call you the night before your surgery to let you know what time to arrive. You will be asked to come to the hospital at least two hours before your scheduled surgery time. As a general rule, you will be asked not to eat or drink anything after midnight the night before surgery. Most often you can take your routine medications with a sip of water. Medication guidelines will be discussed at your pre-operative visit.

Depending on your age, health, and difficulty of surgery, you may or may not need to stay overnight in the hospital. This is typically discussed with your surgeon during your clinic visit. Please leave all valuables at home and wear comfortable clothing.

Medications on Discharge Common medications you may be prescribed on discharge:

1. Pain medication
2. Calcium (TUMS): After parathyroid surgery, all patients are discharged home with calcium supplementation. Parathyroid glands regulate calcium levels in the blood. The calcium is necessary due to removal of the overactive gland and the remaining “sleepy” parathyroid glands. The remaining glands are usually underactive for a few days after surgery. If the remaining glands are underactive, you may have low calcium levels. A low calcium level is typically a short term problem treated with calcium supplements. Signs of low calcium include numbness and tingling around the lips and in the fingers and toes. If you experience these symptoms, please notify the office.
3. Vitamin D (Ergocalciferol, calcitriol): If your Vitamin D levels are low before surgery, you will be given a supplement to take. After surgery, you may require a different form of Vitamin D (calcitriol) because your parathyroid glands may produce a low amount of parathyroid hormone, which will make your calcium levels low. This is not always necessary in all patients.

After Surgery

Approximately 1-2 weeks following surgery, you will return to clinic to meet with your surgeon. At this time you will also meet with a nurse or nurse practitioner who will review instructions regarding care for your incision. You will also have some blood work checked. Depending on the results of the blood work, you may need to take additional calcium supplementation for a short period of time.

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