DEXTER G. TURNQUEST, MD PA
Adranal Gland Surgery
The adrenal glands are small darkly colored organs found in the area near the top of each kidney. These glands are hormone machines, which effect many other systems in the body: Body fluid and salt regulation, adrenalin (or epinephrine), b
lood pressure, m
uscle development, s
exual drive and s
ugar metabolism.
Diagnosis
The diagnostic testing required for adrenal conditions is complex, and is dependent on the tumor type. Often a complete endocrine work-up will help determine whether the adrenal is acting alone, or indicate if a pituitary tumor is driving the adrenal gland to produce more hormone. A CT of the pituitary, blood hormone levels and appropriate consultation with specialists are required.
Treatment
What conditions require adrenalectomy? Usually only one adrenal is absolutely necessary to sustain a normal life. Taking out an adrenal gland, adrenalectomy, is performed for both malignant and benign health conditions. Conditions that benefit from adrenalectomy: pheochromocytoma, benign tumors as evidenced by CT findings, c
ysts or tumors which secrete hormone. The laparoscopic technique offers excellent visualization of the adrenal structure and also gives the surgeon the ability to look at both left and right adrenals without the long incisions once required. Removal of one adrenal can adequately be done by laparoscopic methods. It is very rare that both adrenals are malfunctioning, but if both are removed (and sometimes with one gland removed) hormone replacement therapy may be necessary. Close postoperative follow up with a physician specializing in endocrinology is mandatory.
DEXTER G. TURNQUEST, MD PA
DISCHARGE INSTRUCTIONS FOR THYROID OR PARATHYROID SURGERY
ACTIVITY:
· Walking around the house, climbing stairs, riding in a car or light office work is fine as soon as you feel able.
· It may not be comfortable to do hard physical activity or sports (e.g. swimming, skiing, tennis, weight lifting or contact sports) for several weeks.
· You can usually go back to a full-time work schedule in 1-2 weeks. It may take longer to return to heavy physical or other demanding work.
· Sexual activity is safe as soon as you are comfortable.
· Do NOT drive a car until you are able to turn the neck side to side, which may take 1-2 weeks.
· Do NOT drive while you are taking pain medicines.
DIET:
· You may have temporary throat discomfort or difficulty swallowing. This is due to the surgery around your larynx (voice box) and esophagus (swallowing tube).
· Drink and eat foods that can be swallowed easily, (e.g. juice, soup, gelatin, apple sauce, scrambled eggs or mashed potatoes)
· You may be able to return to your usual diet in a couple of days.
· If you had an operation for thyroid cancer, you may need to prepare for radioiodine scanning and treatment. Eat a special diet with no iodine.
· Do NOT eat iodized salt, sushi, seaweed, dairy products, commercial white bread, medications or vitamins that have iodine in them.
· If you had parathyroid surgery, you may need more calcium in your diet.
· Eat broccoli, spinach, clams, scallops, milk, yogurt, cheese, ice cream and cottage cheese.
· If you have lactose intolerance, you may need calcium pills.
INCISION CARE:
· Keep the incision dry for 24 hours after surgery. After that you may get the neck wet.
· Pat the incision dry. Do NOT scrub with soap or wash cloth for the first 10 days.
· If you have stitches to be removed, that will be done on the first or second day after surgery.
· Leave the Steri-Strips (small white adhesive strips) on your incision for 10 days. Then you may remove them.
· Mild swelling at the incision site will go away in 4-6 weeks. The pink line will slowly fade to white during the next 6-12 months.
· Avoid having too much sun or sunburns while the incision is healing. Use a sunscreen (SPF #30 or higher) or wear a scarf for protection.
· You may begin to use a moisturizing cream along the incision after 2 weeks.
COMMON PROBLEMS:
· Numbness of the skin under the chin or above the incision is normal and should go away in a few weeks.
· You may feel a lump or pressure in your throat sensation swallowing for a few days.
· Your incision may feel itchy while it heals. Avoid rubbing or scratching if possible.
· You may feel neck stiffness, tightness, a pulling feeling, mild aching, chest discomfort, headache, ear pain or congestion. Take a mild pain medicine such as Tylenol or Advil. Put heat on the area using a hot water bottle, heating pad or warm shower.
· Your voice may be hoarse or weak. Pitch or tone may change. You may have difficulty singing. This usually goes back to normal over 6 weeks to 6 months.
· After surgery, you may notice a change in your mood, emotional ups and downs, depression, irritability or fatigue and weakness. These changes in your personality will get better a time passes.
HORMONES AND MEDICATIONS:
· You may have to take Synthroid or Levoxyl when you go home. These are identical to the hormone made by the thyroid.
· Take the medication as you are instructed.
· If you are taking calcium pills (Os-Cal or Tums) or vitamin D (Rocaltrol or Calcitriol), make sure you take the medicine exactly as directed.
· If you have parathyroid surgery, you may need to eat a high calcium diet or take calcium pills for a few weeks. You may need a blood test at your follow-up visit.
· Most patients do not need strong pain medicine by the time they leave the hospital. You can take 2-3 regular Tylenol (acetaminophen) tablets or 1-2 Extra Strength tablets to relieve your pain if needed.
CALL YOUR DOCTOR IF:
· Your temperature is greater than 101F (or 38.3C).
· You have continued drainage from the incision, constant numbness in your fingers, repeated choking, difficulty breathing, severe pain or increasing swelling or redness.
FOLLOW-UP:
· If you do not have an appointment for a follow-up visit, call our office to set up an appointment for approximately two weeks after surgery.
· For any questions that are not emergencies, call the nursing unit where you were a patient.
· In case of emergencies, call our office and/or go to the Emergency Room.