A parathyroid gland is any one of the four small, round glands at the back of the thyroid, which are responsible for the regulation of calcium in the bloodstream. They control the calcium level by affecting a variety of organs including the kidney, intestines, and bones. Despite their close proximity, the thyroid and parathyroid are very different glands with very different purposes and the problems that affect them must be understood and dealt with accordingly.
However, whether we are performing thyroid surgery or looking into a possible parathyroid problem, we use advanced techniques to perform diagnostic and surgical; procedures with minimal damage to surrounding tissues. This minimally invasive approach significantly reduces the risk of surgical complication as well as shortening healing time.
Hyperparathyroidism is a condition in which the parathyroid creates more of the parathyroid hormone than it needs to, causing an imbalance in the amount of calcium in the body. This can lead to problems with the bones, muscles, nervous system, and kidneys.
The most common form of this condition is primary hyperparathyroidism, which is caused by either an adenoma (benign growth) or enlargement of all of the parathyroid glands. Parathyroid adenomas are the most common cause of primary hyperparathyroidism and can occur in more than 90% of cases. 5-10% of cases are caused by disease in more than one gland.
Less common is secondary hyperparathyroidism, in which an underlying medical condition (usually kidney failure) triggers the malfunction of the parathyroid. Treatment for hyperparathyroidism depends on the type and degree of the condition. Primary hyperparathyroidism is most effectively treated with surgery to remove the affected glands, while secondary hyperparathyroidism is best addressed by treating the underlying medical problem.
Calcium is used by every cell and organ in the body to function; as such calcium imbalance can have a wide range of signs and symptoms.
The severity of symptoms does not go hand in hand with the level of rise in calcium. Some patients with slight elevation in calcium will have severe osteoporosis. Because the symptoms are so non-specific and the patients can have any combination of symptoms, they are not appropriately diagnosed as having a parathyroid disorder, and the patients go untreated. Interestingly enough even the patients who are without symptoms find that they feel much better after surgery.
In several medical studies it has been shown that 95% of patients state they feel better after surgery. As early as 72 hours after surgery, most patients feel an improvement in many of the symptoms. All patients with hyperparathyroidism will develop osteoporosis. Taking medications such as Fosamax or Actonel will not help bones that are less dense due to parathyroid disease. Long-standing elevation in calcium places a heavy burden on the body and has been proven to lead to a decreased life expectancy. Parathyroid disease only gets worse with time in everyone. It will continually change, and will not get better on its own.
Physicians recognizing a combination of signs and symptoms make the diagnosis. However, in most cases routine laboratory tests show a persistent increase in blood calcium levels. Checking the level of parathyroid hormone PTH follows this. A combination of an elevated calcium and PTH level confirms hyperparathyroidism. However, there are times when the calcium stays elevated without a significant elevation in PTH. A fluctuation in the blood calcium level from high to normal range and high again is a frequent occurrence in patients with parathyroid disease.
Identifying the location of the abnormal parathyroid gland (parathyroid adenoma) is very important in planning the surgical treatment. Dr. Larian can identify the great majority of abnormal parathyroids by performing an ultrasound in his office. If the ultrasound imaging does not locate the abnormal gland then Dr. Larian will proceed to use either the sestamibi/SPECT Scan or 4D high-resolution CT scan. However, it is important to understand that both of these scans are very complex, require an experienced technician, and have radiation exposure, which is why Dr. Larian only utilizes these tests when the initial ultrasound is negative. Dr. Larian’s primary goal is to give each patient the dedicated care and attention they deserve to cure their hyperparathyroid disease.
There are no drugs that can effectively treat parathyroid disease. Surgery is the only successful treatment for primary hyperparathyroidism. The surgery is called parathyroidectomy and it means to remove one or all parathyroid glands. The traditional surgical approach involved a large incision and exploration of both sides of the neck. Dr. Larian is one of the few surgeons in the country performing minimally invasive parathyroidectomy via a small incision as well as intra-operative PTH hormonal assay to ensure a more effective and less invasive procedure.
Primary hyperparathyroidism that is significant enough to need treatment is traditionally addressed by removing the affected parathyroid gland or glands. Although this procedure was once extremely invasive, newer techniques allow us to access the parathyroid through very small incisions (less than an inch), resulting in minimal trauma to surrounding tissues and a much shorter recovery period. This is especially true in cases of parathyroid adenoma, where the adenoma has been located through various studies (Sestamibi, CT Scan). By using rapid intra-operative PTH testing we confirm the success of surgery and an appropriate drop in the PTH level in the operating room. Due to the ease of this procedure, in certain cases it can be done under loco-regional anesthesia.
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