Hyperparathyroidism
Background: The parathyroid glands are 4 tiny endocrine glands that are located right behind the thyroid in the neck. They control the circulating blood calcium level by secreting a hormone called parathyroid hormone (PTH). Occasionally, one or more parathyroid glands becomes enlarged and starts to produce excessive amounts of parathyroid hormone. The extra parathyroid hormone causes the bones to dissolve and this raises the blood calcium level. This disease is called hyperparathyroidism.
- 100,000 new hyperparathyroid cases a year in USA
- 2 out of 1000 people affected
- Affects women 3 to 1 over men
- Caused by overactive parathyroid glands in the neck- usually just one gland, but occasionally multiple glands
- Diagnosed when blood calcium is high (>10.5). Increased blood calcium is caused by increased blood parathyroid hormone levels (>65) . Excessive parathyroid hormone is released by the overactive parathyroid glands mentioned above.
- Hyperparathyroidism can cause:
osteoporosis (bone loss) which can result in bone fractures, spinal cord compression, and bone pain; kidney stones which can cause severe abdominal pain and kidney infections; abdominal pain from stomach ulcers and pancreatitis; depression, fatigue, muscle aches and pains, excessive urination at night and nerve damage.
- Luckily, hyperparathyroidism can be easily treated.
- Surgery is the preferred method of treatment and can usually be performed in a minimally invasive fashion.
- Surgery is the only permanently effective treatment if the symptoms mentioned above are associated with high blood calcium levels. Patients with these symptoms and calcium levels less than 10.2 should speak with their primary care physicians about alternative treatments.
- Patients with kidney failure and high calcium levels are often not candidates for surgery and should discuss medical treatment options with their nephrologists. Surgical cure is likely if the surgeon is experienced (>100 neck surgeries a year) and knows pre-operatively where the abnormal glands are located in the neck (otherwise, it’s a needle-in-a-haystack search). Recent advances in technology have allowed for pre-operative localization of abnormal parathyroid glands.
- Patients should undergo pre-operative out-patient nuclear parathyroid scanning (Sestamibi scan) and diagnostic high resolution neck ultrasound.
- Endocrinology physicians with neck ultrasound training are experts at locating abnormal parathyroid glands.
- Radiologists often fail to identify enlarged parathyroids.
- Dr. Harrell, of Ft. Lauderdale Endocrine Surgery, has specialized training in diagnostic high resolution neck ultrasound and has performed over 5,000 of these procedures since 1991.
- Adequate pre-operative localization of abnormal parathyroid glands is imperative for successful minimally invasive parathyroid surgery. Otherwise a full neck exploration is required to examine all of the parathyroid glands (to determine which glands are abnormal).
- Minimally invasive radioguided parathyroid surgery (MIRP), is performed through a one inch incision, is associated with a low risk of injury to other neck structures, and is usually associated with a same day discharge after the surgery is complete. Full neck exploration, on the other hand, requires a 2-3 inch incision, can be complicated by injury to structures on both sides of the neck, and most often requires a 2-3 day hospital stay.
- Assurance that your minimally invasive surgeon has successfully removed the abnormal parathyroid glands is obtained at the end of the procedure by the use of intra-operative parathyroid hormone testing. If intra-operative parathyroid hormone testing is not performed, then an abnormal parathyroid gland (which was not identified preoperatively) may remain in your neck and a SECOND SURGERY MAY BE REQUIRED FOR CURE.
- Successful surgical treatment of hyperparathyroidism not only requires sophisticated technology and specialized skills, but also teamwork between your endocrinologist and endocrine surgeon. FACE-TO-FACE COMMUNICATION IS ESSENTIAL.
- Drs. Harrell and Bimston, of Ft. Lauderdale Endocrine Surgery, have pioneered a new, coordinated and multidisciplinary approach for the evaluation and removal of parathyroid tumors, using minimally invasive techniques.
- Using intra-operative parathyroid hormone testing technology and minimally invasive surgical techniques (MIRP), Dr. Bimston can remove one or more abnormal parathyroid glands, document cure and immediately send patients home after an elegant same-day surgery.
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