After Your Operation

Taking Calcium After the Operation

Your blood calcium has been high for years, and it will start going down after the operation because the parathyroid tumor that was causing the high calcium has been removed. Your remaining parathyroid glands have been dormant (asleep) as long as your calcium has been high. It will take a few days for these normal parathyroid glands to “wake up” and start controlling your calcium like they are supposed to. They will always wake up and you should not worry about this.

Smooth transition from high to normal

The goal of taking calcium after the operation is so that we get a nice, smooth transition from a high calcium level (which you have had for years) to normal calcium levels over a period of a week or so. Also, we want to take advantage of the fact that your bones will begin a rapid “healing” phase and will absorb a lot of calcium for the first week after the parathyroid tumor has been removed. Thus, taking calcium after a successful parathyroid operation is essential to a good outcome.

If you don’t start taking calcium pills within hours of the operation, your calcium may go too low, and you can develop symptoms of LOW calcium. If you take your pills, you will be fine. Your nurse will give you the first calcium pill about 15 minutes after your operation. Most people don’t remember taking this pill because they are still sleepy from the anesthesia. Before you leave the hospital, your nurse will go over your calcium schedule with you for the rest of that day.

Calcium citrate works the best

We prefer Citracal + D brand, which is available at most grocery stores and pharmacies. Generically it is called calcium citrate, but Citracal is the most common brand of calcium citrate. You should buy a bottle of this and bring it with you to the hospital and on your trip to Tampa. You will need this bottle with you, so don’t forget it. If you do forget it, we have a back-up plan!

Follow the calcium schedule

Our calcium dosing schedule has been developed over a period of 20 years and over 30,000 patients. We have published prospective trials on this in 6,000 patients looking at various amounts and the patient’s vitamin D levels. It turns out that the patient’s vitamin D levels have no influence at all on the amount of calcium a patient needs after parathyroid surgery.

  • 5 pills the day of surgery
  • 5 pills per day for the first week after surgery
  • 3 pills per day for the second week
  • 2 pills per day for several months (if you are a man with normal bones), or for life (if you have osteoporosis).

You must continue to take the calcium pills as outlined in other areas of this app, and in the papers we hand you at the hospital (or as advised higher or lower by one of your surgeons). If you take the calcium as outlined above there is very little chance you will get low calcium symptoms. If you don’t take your calcium (and even some of you that do take it) you may develop symptoms of LOW calcium a few days after your operation. Note that symptoms of low calcium never occur the day of surgery or the next day. The symptoms of low calcium generally start two or three days after the operation.

The first symptoms of low calcium are usually numbness and tingling in your fingers or around your mouth. If you get these symptoms, then you need to take extra calcium pills. It is not dangerous as long as you take more calcium pills. It will get better. The chance that you will have low calcium (hypoparathyroidism) forever is about zero if you had surgery with us. If you have low calcium symptoms, it typically lasts only 1-3 days.  So, you will need extra calcium for a few days, and then get back on the schedule above.