Parathyroid Disease & Surgery
Hyperparathyroidism
Parathyroid Glands
The parathyroid glands are four small glands located in the neck that are responsible for controlling the calcium level in our blood. Despite the name similarity, the thyroid and parathyroid glands are not the same and serve very different functions. Problems with the parathyroid glands do not translate into problems with the thyroid gland which is under a different type of control.
The most common problem affecting the parathyroid glands is hyperparathyroidism (HPT), when one or more of the glands become too active and no longer follow the normal body signals to shut down the production of parathyroid hormone. As a result, the calcium level in the blood will rise and can affect many of the internal organs such as bones, muscles, kidneys, gastrointestinal tract, and even memory and mood.
Causes
Hyperparathyroidism or elevated parathyroid hormone is most often caused when one gland is enlarged because of a noncancerous growth (adenoma). In the minority of cases, more than one gland can be diseased. Parathyroid cancer is very rare and accounts for only 1% of hyperparathyroid cases. Hyperparathyroidism is a very treatable problem and surgical removal of the abnormal gland or glands is the only curative treatment.
The diagnosis of hyperparathyroidism is often made by a blood test that examines your blood for calcium, parathyroid hormone, and vitamin D levels. In addition, once the diagnosis is made, your doctor may choose to do additional studies to determine whether some of your most commonly affected organs have been involved. This may include a urine sample to test whether there has been any damage to the kidneys.
Along the same lines, a bone density study can show whether having had hyperparathyroidism has affected your bone health. The bony areas most often tested are hips, lower back, and forearm.
Symptoms
It is common for patients with hyperparathyroidism not to know that they are affected. This is because the signs are usually very mild and vague. Patients often attribute these symptoms to other health reasons or life stressors. Some patients may experience the following:
- Depression
- Difficulty concentrating
- Forgetfulness
- Constipation
- Abdominal pain
- Excessive thirst
- Excessive urination
- Kidney stones
- Joint or bone pain
- Muscle weakness
- Bone loss
- Broken bone
Treatments
Surgery is the only cure for primary hyperparathyroidism. The vast majority of our patients are candidates for minimally invasive or focused parathyroidectomy. This process is initiated by localizing the abnormal gland with specialized imaging by one of our dedicated endocrine radiologists. Once this is accomplished, a focused exploration of the neck through a less than one-inch incision is performed and the abnormal gland is removed. This often eliminates the need for a more extensive surgery involving exploration of both sides of the neck. In addition, this technique offers a more aesthetic incision, a shorter operating time and a lower incidence of postoperative hypocalcemia. The procedure is most often performed with a combination of local and general anesthetic to optimize patient comfort and safety. In appropriately selected patients, minimally invasive parathyroidectomy can often be performed as an outpatient.
Parathyroid Imaging
The parathyroid scan is the best non-invasive method for identifying the location of an abnormal parathyroid gland. Most abnormal parathyroid glands are located in the anterior neck, around the thyroid gland, but can occasionally be found in the chest.
On the day of imaging, you should come prepared to spend up to four hours in the Diagnostic Imaging department. Once the molecular tracer is injected into the vein, you will be resting comfortably on an imaging table while the imaging camera moves around you. Several nuclear medicine images are acquired over a period of 3 hours. This procedure is painless.
Most patients also require an ultrasound to confirm the position of the abnormal gland. This technique is safe and uses no radiation. On rare occasions, additional imaging with CT or MRI may be required preoperatively.
Parathyroid Surgery
What to Expect
After surgery, many patients will be able to go home the same day or the following morning. Recovery is fairly quick and the procedure causes little discomfort. Patients usually resume normal activity within a couple days and some patients return to work within days of the surgery.
Diet: You may experience some decrease in your appetite, nausea and occasionally vomiting. Therefore you may do better with light meals for the first 24-36 hours following surgery.
Activity: Do not engage in potentially hazardous work or make important personal or business decisions if taking pain medications. No driving until narcotics are no longer required for pain control is advisable.
Elevate the head whenever possible. When sleeping use 2-3 pillows if possible. Most patients can resume normal activity within a couple of days of the surgery. We recommend that patients avoid driving until they are comfortable moving their neck in all directions and until they are OFF narcotics.
Wound: Your bandage may be removed 24 hours after surgery but leave butterfly strips in place. You may notice some bruising around incision or below your scar. Avoid baths, but you may shower 24 hours following surgery.
The scars are usually hidden in natural skin folds in the neck and usually heal well becoming less pronounced with the passage of time.
Medication: Take pain medication and supplements as instructed. Keep in mind that pain medications can sometimes cause nausea and are better tolerated if taken with some food. If you develop constipation, you may use over the counter stool softeners such as Surfak or Dulcolax 1-2 times daily. We are unable to refill medications on the weekend. Please call your pharmacy to obtain a refill. We can work directly with them to expedite the prescription.
The month following surgery, patients will take calcium with Vitamin D, until the remaining parathyroid glands have regained their normal function. If you develop numbness or tingling around your mouth or fingertips, take 2 additional calcium pills and contact your physician as this may represent a sign of low calcium levels.
We are unable to refill medications on the weekend, please call during office hours Monday-Friday 9:00am-4:00pm.
Follow Up: Please schedule an appointment for a post-operative exam 2 weeks following surgery. You should also get your calcium and parathyroid hormone levels checked 6 month following surgery. Call the office at 503-963-2910 and our staff will be happy to make the necessary arrangements for you.
Frequently Asked Questions
Parathyroid surgery today is safe and in appropriately selected patients can often be performed in a minimally invasive manner. However any operation has some general and specific risks. The general risks of surgery include reaction to the anesthetic, scar, wound infection, and blood clots. The more specific risks include:
- Bleeding: Bleeding following surgery is rare, but can result in a clot in the neck tissue which can in turn put pressure on the windpipe. This can lead to difficulty breathing and is treated with a second operation to remove the clot.
- Low calcium level (Hypocalcemia): Some patients can experience a drop in their blood calcium below those that are normal following surgery. This is usually treated with calcium tablet and typically improves with time.
- Persistent high calcium level (Hypercalcemia): In less than 5% of patients, the abnormal gland cannot be identified even by an experienced surgeon. This results in continued hyperparathyroidism. Furthermore, even after successful surgery, some patients can develop disease in another one of their glands leading to recurrence of their disease.
- Voice hoarseness: Some patients may experience hoarseness or changes in the caliber of their voice following surgery. In the majority of cases, this is a temporary event. However, in 1-2% of cases, injury to the recurrent laryngeal nerve results in permanent voice changes. Additional surgery or speech therapy can be helpful in some cases. In patients who are public speakers or professional singers, subtle changes may result from this type of operation.