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Surgery in Parathyroid Disease

Surgery is the only way to treat parathyroid disease. There are no medications or pills that work to cure parathyroid disease. The parathyroid tumor must be removed by a surgeon. As soon as the parathyroid tumor has been removed, you are cured!  It is very likely this will change your life. If you have hyperparathyroidism you need to have parathyroid surgery.

Since 1925, the standard treatment for parathyroid disease (primary hyperthyroidism) has been to surgically remove the parathyroid gland (or glands) which are overproducing parathyroid hormone. Remember, this is a Hormone problem, so the goal is to remove the source of the excess parathyroid hormone (remove the bad parathyroid gland, leave the normal parathyroid glands).

Again, the concept is really quite simple: Find which parathyroid gland has become a tumor and is making too much parathyroid hormone and take it out, leaving the other normal parathyroids alone. The normal parathyroid glands will take over and you will be cured. You don't need all four parathyroid glands


The standard parathyroid operation has not changed since its invention in 1925, and is performed by putting the patient to sleep under general anesthesia. An incision is made in the neck, the muscles of the neck are retracted sideways and the thyroid gland is loosened up and moved aside to allow the surgeon to identify the four parathyroid glands which reside moderately deep in the neck behind the thyroid.

Patients having a 'standard parathyroid operation' are always hospitalized over night, and sometimes as long as two days. The incision for the standard parathyroid operation has to be made of sufficient length to allow the surgeon adequate exposure of the numerous important structures within both sides of the neck, and thus it is typically six or seven inches long.
Because of the numerous small nerves and other important structures within the neck which reside around the parathyroid glands, the 'standard' parathyroid operation has the best results when performed by experienced surgeons

During the standard operation, the surgeon must identify all four parathyroid glands and remove whichever one(s) is enlarged. The vast majority of time there is just one large parathyroid gland (an adenoma which is a benign parathyroid tumor) and three normal parathyroid glands. In this situation the one large gland (the parathyroid adenoma) would be removed leaving the three normal parathyroid glands to function in a normal fashion indefinitely. If the surgeon found all four parathyroid glands to be enlarged (found in only 2-3% of patients and called "parathyroid hyperplasia"), he would typically take out 3 or 3-1/2 of these glands leaving some parathyroid tissue behind to function normally in the future. To complete a 'standard parathyroid operation' safely with a high rate of success, the operation occurs on both sides of the neck (a standard bilateral neck exploration), and is always performed using general endotracheal anesthesia.

NOTE: “Minimal parathyroid surgery” is dramatically changing the way endocrinologists treat parathyroid disease, sending almost all of their patients for surgery.

Overview of Standard Parathyroid Surgery for Primary Hyperparathyroidism

  1. You have 4 parathyroids, so all 4 are examined to see which ones are enlarged.
  2. If one bad (enlarged) parathyroid is found, it is removed (95% of cases)
  3. If 4 overactive glands are found, 3 or 3 1/2 are removed (5% of cases)
  4. Requires general anesthesia (extremely safe these days, usually associated with more hospital time).
  5. Risks are dependent upon surgeon experience.
  6. Complication rates extremely dependent upon the experience of the surgeon.
  7. Expected blood loss is low (less than 1/4 cup no need to prepare for possible transfusions).
  8. Standard parathyroid operation is expected to take 2 to 3 hours, but may take as long as 4 hours or as short as 1 hour.
  9. The incision is usually heals nicely. Almost unheard of to get infected or have a wound problem.

Symptoms of Parathyroid Disease


1- Loss of energy. Don't feel like doing much. Tired all the time.


2- Just don't feel well; don't quite feel normal. Hard to explain but just feel kind of bad.


3- Feel old. Don't have the interest in things that you used to.


4- Can't concentrate, or can't keep your concentration like in the past.


5- Depression.


6- Osteoporosis and Osteopenia.


7- Bones hurt; typically it's bones in the legs and arms but can be most bones.


8- Don't sleep like you used to. Wake up in middle of night. Trouble getting to sleep.


9- Tired during the day and frequently feel like you want a nap.


10- Spouse claims you are more irritable and harder to get along with (cranky, bitchy).


11- Forget simple things that you used to remember very easily.


12- Gastric acid reflux; heartburn; GERD.


13- Decrease in sex drive.


14- Thinning hair (predominately in older females).


15- Kidney Stones.


16- High Blood Pressure (sometimes mild, sometimes quite severe; up and down a lot).


17- Recurrent Headaches (usually patients under the age of 40).


18- Heart Palpitations (arrhythmias). Typically atrial arrhythmias.

Most people with hyperparathyroidism will have 4 - 6 of these symptoms. Some will have lots of them. A few people will say they don't have any but after an operation they will often say otherwise. 95% of people with hyperparathyroidism will have 3 or more of these symptoms. In general, the longer you have hyperparathyroidism, the more symptoms you will develop.


The Basics of Diagnosing Parathyroid Disease:

Since parathyroid glands are glands within the endocrine system, we can detect parathyroid disease by measuring the hormone that the parathyroid glands make and compare this level to the amount of calcium in the blood. All endocrine glands make hormones, and all hormones have a "normal" level in our blood. If an endocrine gland develops into a tumor, it will over-produce its hormone. The hormone has effects on other parts of the body (that's what hormones do!!). In the case of a parathyroid gland tumor, it overproduces PTH which in turns takes calcium out of the bones and puts it into the blood. It is the high calcium in the blood that makes us sick!

1-Parathyroid glands make parathyroid hormone.

2-Parathyroid hormone controls calcium in the blood.

3-There is a normal range for parathyroid hormone in the blood.

4-If the blood calcium level is too HIGH, it should be associated with a LOW parathyroid hormone level if the parathyroids are normal (a normal parathyroid will shut down and go to sleep if the calcium level is high).

5-A blood calcium level that is too HIGH, and is associated with a HIGH parathyroid hormone level MUST be due to a tumor in the parathyroid gland. That is, the high blood calcium is a result of the excess parathyroid hormone (PTH). It is the parathyroid gland that is the problem.

A person with high blood calcium that has a high parathyroid hormone level at the same time must have a bad parathyroid gland.
  These are the EASY cases of hyperparathyroidism to diagnose! All doctors should be able to make the diagnosis of hyperparathyroidism if the calcium is high AND the PTH level is high at the same time.
HOWEVER, many people (about 20% of all patients with hyperparathyroidism) will have parathyroid disease when they have high calcium and NORMAL PTH levels. The point here is that the parathyroid gland is still the problem. Let's keep it simple now: high calcium + high PTH = parathyroid tumor.
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