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Surgery for overactive parathyroid gland(s)

Hyperparathyroidism means that the parathyroid glands are producing an excess of a hormone called parathyroid hormone, which in turn causes elevations in the levels of calcium circulating in the bloodstream.

Primary hyperparathyroidism has become a relatively common condition, especially among the elderly. The incidence of this disease is approximately 25-28 cases/100,000 people per year. Among white women older than 60 the incidence actually approaches 190 cases/100,000 women/year.

Parathyroid function
The only role of the parathyroid in the human body is to regulate the levels of calcium in the bloodstream. Indirectly, therefore, the glands, working in unison in a normal situation, determine the strength and integrity of the bones. If there is too much calcium leached from the bones, then a condition called osteopenia and osteoporosis occurs.

              

The parathyroid glands have no functional relationship to the thyroid gland. When the calcium levels get too high, typically above 10.5, the patient complains of abdominal pain, tiredness, irritability, depression, memory loss, and, sometimes, kidney stones. Many patients, however, have little or no complaints associated with the elevation in calcium. More often than not, today the discovery of hyperparathyroidism is associated with a routine blood test that finds an elevation in the blood calcium level.

The challenge
Although most people are born with 4 parathyroid glands, a small percentage of people are born with 3 or 5 of these little glands! And a normal gland is very little indeed. Furthermore, the glands can migrate to some very tricky and ingenious positions in the neck, and can, rarely, be found in the chest. In most situations, the parathyroid glands are normally intimately associated and attached to the adjacent thyroid gland. Luckily, the vast majority of people who have hyperparathyroidism have only one of these glands enlarge to cause the problem.

Minimal radioguided parathyroid surgery
The best treatment for this disease is surgery to remove the gland(s) which are enlarged and responsible for the elevations in calcium in the blood. Up until very recently, there was no reliable test available to actually locate (medical term, localize) the enlarged parathyroid gland.

               

Several years ago a new test, called technetium-sestamibi scanning became available. A relatively simple test, the sestamibi is attracted to the enlarged parathyroid gland. It is an extremely accurate and sensitive test. Because of our strong interest in treating this disease, we became the first group in the Delaware valley to utilize this technique and perfect its use for our patient population.

We soon coupled this test with our extensive interest and experience in parathyroid surgery.

The standard surgery requires many hours of searching for the enlarged abnormal gland.

Minimal Radioguided parathyroid surgery is exactly what it sounds like. On the day of the planned operation, the patient is admitted several hours prior to the expected time of the surgery. Our specially trained nuclear medicine technologist and radiologist then performs a painless noninvasive technetium-sestamibi scan which, approximately 90% of the time, identifies the exact location in the neck of the enlarged parathyroid. The radiologist then marks the location on the skin with a skin marker, and the patient proceeds to surgery.

Once the patient is asleep, we use a hand-held probe to take us to the area of increased activity, most often allowing us to identify and remove the enlarged parathyroid gland in 15 minutes through a smaller incision than would be required without this new scan and tool.

This technique has changed what used to be a very long operation into a generally less invasive, much shorter and easier procedure for the patient. Hospital stays are typically less than 24 hours and patients are most often discharged without any medication other than a mild analgesic like tylenol.

We are proud to have pioneered this procedure and to have authored an early manuscript describing this procedure. In addition, we have taught a course on radioguided parathyroid surgery to other professionals. This procedure is performed in a comfortable community hospital setting from beginning to end by board certified surgeons. Only Dr.s Baskies and Holaday, with a combined 40 years of experience, perform this operation, and our nuclear medicine technologist, Linda Davis, and radiologist, Dr. Paul Mayer, round out the dedicated parathyroid surgery team.

For much more information on parathyroid (and thyroid surgery), visit: www.parathyroidglands.com

 

 

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