Asked Questions About Parathyroid Surgery, Minimally Invasive (Mini)
Parathyroid Surgery, and Choosing Your Parathyroid Surgeon.
Do all surgeons perform parathyroid
No. For many years, general surgeons,
and some ENT surgeons have performed parathyroid
surgery. However, like all other forms of surgery and medicine,
the treatment of parathyroids is becoming very specialized. Most
general surgeons perform breast surgery, hernias, gallbladders, and
numerous intestinal/abdominal operations. The typical general surgeon
performs less than 2 parathyroid operations per year. The results of
this 'lack of experience' shows in multiple publications, with lesser
experienced surgeons having successful outcomes after parathyroid
surgery in only about 85% of cases. We operate on people EVERY DAY who has had an operation performed by a general surgeon
and they are not cured, and often have had a serious complication. You
MUST choose your surgeon wisely! The most important information we can
give you is that you should pick a surgeon that performs 50 or more of these operations per year...otherwise your chance of a
poor outcome or a serious complication is higher. And... if you see a surgeon that tells you he/she does 50
parathyroid operations per year, ask them if this includes thyroid
operations... its NOT the same! Click
to read more.
Remember... the main purpose of this web site
is to educate patients AND DOCTORS about parathyroid disease. We
have plenty of patients and don't need this web site to get
patients... Over 90% of our patients are sent to us by their
endocrinologist. We can't operate on every parathyroid patient in
the US, nor do we want to... but PLEASE, pick your surgeon wisely
or you will have to come here for your second operation! If your
doctor sent you to a surgeon who is not performing parathyroid
operations every week, then find a different surgeon. If you have
to travel to another town to do so, then please do! Statistics
don't lie, and experience is what really counts. Nearly 20% of our
operations are on patients who let an inexperienced surgeon
operate on them. Most of them have had their normal
parathyroid glands removed and the tumor is still in their neck!
Don't General Surgeons get trained to
perform parathyroid surgery during their residency training?
Yes, and no. The American Board of Surgery is the
group that monitors surgery residencies and certifies surgeons to
perform surgery. Between the years 1990 and 2000, the average number
of parathyroid operations performed by surgeons upon completion of
their residency was 2. In other words, the typical surgeon has
performed only 2 parathyroid operations total when they become
'board certified' in general surgery. However, once a surgeon is board certified
they are allowed to do any operation they want--even if its an
operation they have never done before in their life. Parathyroid
disease is uncommon, and about 1/4 of all surgery residents (surgeons in
training) graduate and become board certified having done ZERO
parathyroid operations. As you have read in other areas of this web
site, the most variable anatomy in the entire human body is the
anatomy of the parathyroid glands. This explains the often poor
results seen with parathyroid surgery, and the reluctance of
endocrinologists to send patients for parathyroid surgery. In the February 10th, 2003
Times, there was an article about the dangers of having
surgery for a delicate operation when the surgeon only does a few per
year. Parathyroid surgery is one of those operations. Footnote
for surgery training statistics: Harness
JK, et al, Surgery 1995; These same experts have suggested that
thyroid and parathyroid surgery should be done at specialty centers;
their conclusions: Organizing teams of specialists into thyroid
centers (centers of excellence) can (1) increase efficiency; (2)
increase quality of care; (3) decrease costs; (4) encourage a more
individualized approach to surgery; (5) lower complication rates; and
(6) foster innovation in technology and disease management.: Harness
JK, et al, World Journal of Surgery 2000.
My surgeon says he does mini-parathyroid
surgery. How can I tell if he really does mini-surgery?
Surgeons are typically very smart and talented
individuals. They know that patients want the most advanced operation and the least
invasive operation. And, almost always, surgeons want to provide this
to the patients knowing it is in the best interest of the patient
also. Some surgeons, however, will occasionally tell the patients what they
want to hear. So be informed and ask these few questions: 1) Will I have to spend
the night in the hospital after the operation? If the answer is
"Yes", then the chances are high that the operation planned
is not a mini parathyroid operation or this surgeon may not be very experienced
parathyroid surgery. Of course, no surgeon can predict the future, and
the primary goal of the surgeon is to take care of you safely... so it
is possible that you will have to spend the night in the hospital even
if you have the best parathyroid surgeon in the world.
almost NEVER requires the patient to spend more than a couple hours in
the hospital after the operation. 2) Will you be putting a drain in my
neck? If the answer to this question is "yes", then ask
There is almost never a need for a drain (to remove blood) to be left
in the neck after a parathyroid operation. If your surgeon routinely
puts a drain in all of his/her patients following parathyroid surgery,
then you should question this. Again, this could be a tip-off that your surgeon
may not be using the most modern techniques and/or that he/she is not very experienced in parathyroid surgery. 3)
What probe do you use a
probe to help find the bad parathyroid gland? Ask which
probe and if they have a probe that is specific for parathyroid
surgery and not just the melanoma and breast cancer probe. Not
everybody uses a probe, but if they do, it must be a probe
manufactured for parathyroid surgery and not breast surgery... they
are different probes. 4) How big will the
incision be? Most surgeons who do 50 or more parathyroid
operations per year (probably only about 12 of these surgeons in the
US) will use a very small incision. For thin people, the incision we
make is about 1 inch OR LESS. For people above 200 lbs it should be about
1.5 inches OR LESS. 5) Will there be stitches or staples to take out? If
there are, then you may want to seek out another surgeon. Those days are gone! 6)
Will you put a breathing tube in my throat to monitor my vocal cords
during surgery? If your surgeon says yes, then you may want to go
somewhere else. This is usually associated with ENT surgeons who don't
do this operation very often. Clearly this is not minimal anesthesia,
and if they need to monitor your vocal cord nerves so they don't
damage them... then that is a BAD SIGN. Surgeons who do this operation
time do NOT monitor the vocal cord nerves... avoid this. 7) How
many parathyroid operations do you perform EACH WEEK? If your
surgeon is not performing parathyroid surgery EVERY WEEK, then you
have a significantly increased chance of NOT getting a mini-parathyroid surgery.
If they are not doing parathyroid surgery weekly, then they are almost
surely not a parathyroid expert, and therefore,
your chances of being cured are lower. REMEMBER... parathyroid disease
is uncommon or rare! So there cannot be an expert in every town! IT IS NOT
POSSIBLE! 8) If you don't find the tumor easily, will
you need to make the incision larger? If your surgeon says
yes, then you have a surgeon that is not as experienced as you would
like. This means that there is near 100% chance you will have a big
incision. Bottom line... if your surgeon isn't doing 50
parathyroid operations per year, then you want to keep looking. Would
you fly on an airplane if the pilot only flew 25 times a year?
|Example of letters that we get
at the Norman Parathyroid Center ALMOST EVERY DAY!
PLEASE PICK YOUR SURGEON CAREFULLY! --
Dear Dr. Norman, On October 31, 2003, I underwent what was supposed
to be a mini-parathyroid procedure at my local hospital. Unfortunately, the
surgery did not go as planned and my surgeon then opened up and took
5 hours to "search" for the adenoma. He proceeded to
remove half of my thyroid and 2 of my parathyroid glands. I found
out later, that he only performs a couple of parathyroid operations
per year!! The trauma
involved in the surgery left both of my vocal cords paralyzed
and led to me having a tracheotomy performed. One vocal cord has
since recovered while the other has not. I give you this history so
that you may know some of the damage that occurred, however, my
question is to do with my remaining 2 parathyroid glands. I am now 4
months post operative and the remaining 2 glands are not
functioning, leaving me with hypoparathyroidism
and I have to take several medications daily (calcium, phoslo,
rocaltrol, not to mention depression medication). Do I still have
hope that the remaining 2 may begin to function? Is there a window
of time that I should hold out hope, or am I basically required to
remain on the medications? My doctors all have different opinions. I
have read your website with fascination and thank you for sharing
your vast knowledge and experience. Unfortunately, I did not know
about your clinic until after my surgery went awry. Thank you in
advance for your time and assistance. Sincerely, S. H.
Response: This is a terrible complication
and it is possibly due to inexperience of the surgeon. Every possible
complication occurred in this patient. She has had all four
parathyroid glands destroyed (BAD!) and both nerves to the voice box
were damaged... so she couldn't breath and had to get a
tracheostomy. She will have a hoarse voice the rest of her life, but
is lucky that she does not need a tracheostomy for the rest of her
will have to be on very high doses of calcium and other medications.
Obviously, every patient in the world cannot come to Tampa to have
parathyroid surgery. HOWEVER, please, do not have this operation
performed by a surgeon that does not do it regularly!!! We get one
or more letters like this almost every day, and it breaks our hearts. Please
be wise! Do not simply go to the surgeon that your doctor sends all
of his/her hernias and breast biopsies to! Please choose your surgeon
I've had an allergic reaction to x-ray
dye. Can I have a Sestamibi Scan?
YES! The material that is used to perform a
Sestamibi Scan is completely un-related to other types of dyes used
for CAT scans, Arteriograms, and other forms of x-rays. Having
an allergy to IVP (x-ray) dye has no bearing on your ability to have a
Sestamibi Scan. We get asked this
question twice a week. Hear us well--- it is not related to any
other scans, and it has no cross-reactivity.
My Sestamibi Scan doesn't show an adenoma.
Does this mean I can't have a MIRP.
Well, it depends on who your surgeon
is. Most surgeons, even some very experienced ones will not do a mini
operation if your scan is negative. HOWEVER, some surgeons will do mini
parathyroid operations on all patients regardless of the scan results. LET
US SAY THIS AGAIN CLEARLY.... SOME SURGEONS PERFORM MINI
PARATHYROID OPERATIONS ON ALL PATIENTS--REGARDLESS OF WHAT THE SCAN
SHOWS! We perform nearly 2000 Sestamibi Scans
per year, more than anyone else in the world. We have
written journal articles and book chapters on our very specific
technique that gives us such wonderful scans. If your scans do
not look clean, crisp and in focus, then your scans could
probably be performed with a different technique that may show your
tumor. The difference in the quality of Sestamibi Scans is
simply appalling. Patients send us their films on a daily basis (we
see about 2200 per year from other hospitals), and
we believe that about half are not of sufficient quality that we would
rely on them for any medical decision. If your scans are not clear
and crisp so that you personally can understand them then ask your doctor to find a
nuclear medicine department that does these on a regular basis. And, take a copy of this technical
page to give to them...its how we do it here. We show our
patients their scan, and over 90% can understand it and show us the
tumor without us having to explain it to them--that's how clear and
crisp the scans should be. HOWEVER, even if
your scan is negative, YOU CAN STILL HAVE MINI-PARATHYROID
SURGERY---this is a decision made by the SURGEON, not the
endocrinologist and not the radiologist. Surgeons don't operate on
x-rays... they operate on humans!!
There are several techniques that should be used for ALL patients to
minimize the size of this operation and to increase cure rate! We perform Minimally Invasive Radioguided Parathyroid surgery on
ALL patients REGARDLESS OF WHAT THEIR SCAN PERFORMED AT THEIR HOME
HOSPITAL SHOWS! We do not choose our patients based upon scan results.
We do not require a scan on our patients before they come here for
surgery. We do NOT require a positive scan for you to be accepted as
our patient. AGAIN---We do NOT care what your scan shows or even if
you had one. All we care about is that your lab values show you have
parathyroid disease. If you do, then you get a MINI-operation.
My Sestamibi Scan shows a 'possible'
adenoma. What does this mean?
It can mean several things. In all of
his publications, Dr Norman defines a
'positive' Sestamibi Scan as a scan that "shows a single focus of
radioactivity which is distinct from the thyroid gland". In
order to do this, there are very specific maneuvers the Sestamibi
technicians must perform to allow for enough detail to be achieved. A
few single adenomas, and those patients with multiple bad parathyroid
glands will not show a positive scan as defined above. Thus,
even at the Norman Endocrine Surgery Clinic, we can expect that about
14% of patients will not have a "positive" scan. About
5-7 percent will have a 'suggestive' scan which indicates a 'possible'
adenoma. The remaining 5-7 percent will be completely
negative--nothing shows up to indicate which parathyroid gland is bad.
Typically these patients have 4 bad glands and not just one, so in
this case the Sestamibi was CORRECT in that it did NOT show a single
bad gland (a 'true negative test'). BUT DON'T WORRY!!! An
experienced surgeon can still operate on you and cure you with a very
safe operation. Talk to your surgeon about this. We
perform MINIMAL PARATHYROID SURGERY EVERY DAY ON PATIENTS WHO HAVE
"NEGATIVE" AND "SUGGESTIVE" SCANS.
ESSENTIALLY 100 PERCENT OF
ALL PATIENTS GET A MINIMAL OPERATION at our center.
Am I too old for parathyroid
surgery? Isn't it too risky at my age?
Surgery always has a risk associated with
it. However, so does having parathyroid disease for several years.
Typically the risk of having parathyroid disease is much higher than
having surgery--especially if mini-surgery is performed! Modern
anesthesia is very safe. Most importantly, however,
Mini-Parathyroid Surgery makes the entire operation safer and
smaller. The anesthesia risk is decreased on an operation that
takes less than 20 minutes on average versus one that takes 2-6 hours. Local anesthesia
can be use for Mini-Parathyroid Surgery and thus a general anesthesia
can be avoided. Drs Norman and Politz have operated on many parathyroid
patients in their 80's and 90's, and one over 100! We operate on
people over the age of 80 about every other day. Bottom line: Age is NOT an
issue and should not prevent a patient from having an
operation--by an experienced parathyroid surgeon. Age IS a reason to
avoid the major parathyroid operation performed by a general surgeon
who may not be very experienced at this operation. Parathyroid surgery is easy if your surgeon is an expert.
One final note:
In 2005 we performed 128 parathyroid operations on patients over the
age of 80. Our average operating time for this group was 16.2 minutes.
The shortest operation took 10 minutes while the longest took 21
minutes. 100% were cured, and 100% went home about 1.5 hours later
with a Band-Aid on their neck. 100% had an incision that was 1 inch or
less. This is why people seek out an expert for their parathyroid
surgery. In May 2007 we published a medial journal article
showing the safety of operating on patients over 80 years of age and
sending them home within 2 hours. The average operative time was under
17 minutes and everybody did great... they all went home within 2
hours. We now operate on people over the age of 80 nearly every day,
sometimes 2 or 3 people over 80 in one day. The article citation is:
Politz D, Norman J. Hyperparathyroidism in patients over 80: clinical
characteristics and their ability to undergo outpatient
What is 'Light Anesthesia'. Why is it better than 'General Anesthesia' in many cases?
The principle requirement is that the patient must
be made numb so they don't feel the tissues being cut. Another
desirable effect is to make the patient 'un-aware' of what is
happening so they don't worry or become too anxious (or talk too
much!). Thirdly, it is often beneficial to have the patient not
remember things in the operating room (give amnesia). General
Anesthesia is when you are 'put to sleep'. General anesthesia
accomplishes all of the above, but it suppresses your brain to such a
degree that a tube must be put down your throat into your trachea so
that a machine can breath for you. Mini parathyroid surgery can
be done via 1) general endotracheal anesthesia, 2) "light"
anesthetic that uses an
anesthesiologist to give a mild sedative in your vein and a soft piece
of plastic to hold your mouth open so you can breath on your own, 3)
local anesthesia with IV sedation, or 4 via a cervical block where the
nerves to the neck are numbed by an anesthesiologist prior to going to
the operating room. Like most of the parathyroid experts world-wide,
we have used all of these techniques at one time or another as the
situation dictates. We now use the light anesthesia with an LMA airway
on almost all cases. The combination
of drugs that the anesthesiologist can give makes the surgery painless, and keeps the patient quiet
and restful. They breath on their own, and wake up more
refreshed than after general anesthesia. They can typically go home in
an hour or two. Depending on the patient, light anesthesia with IV sedation
can be less
risky to the heart and other organs than general anesthesia. You are "asleep" enough that
you don't feel or remember anything, but you are awake enough that you
don't have to be put on a breathing tube that goes into your trachea.
Since we tilt your head back a bit to get access to the parathyroid
tumor, we typically put a small piece of soft plastic in the back of
your mouth to keep your tongue out of the way so you can breath good
(this is the LMA).
You will NOT be aware of any of this, and you will NOT feel any of
this. Bottom line, some expert parathyroid surgeons use other methods
that work well for them and their patients in their hospital. Trust
your surgeon on this!!! However, most patients can avoid the
full endotracheal general anesthesia. And... as noted above, as a
general rule, avoid surgeons who use a tube to monitor your vocal cord
nerves. Our data shows these surgeons have the worst complication
rates... not opinion... this is factual.
If the parathyroid operation is performed
under "Light Anesthesia", wont I be too awake and nervous?
This is an excellent question. The anesthesiologist will
be giving you some sedative medication into your veins. This will make
you sleepy, restful and quite peaceful. You will be awake enough to
move yourself onto the operating table, but then you will just close
your eyes and relax and go to sleep. The nice thing about these new sedative
medications is that they wear off quite quickly, so when the
anesthesiologist turns it off, the patient typically wakes up and
feels quite normal within a few minutes. All patients are monitored by
the anesthesia team during the entire procedure (like a major surgery)
for safety reasons. You will not know what is going on, and you will
have no memory of the procedure. You will be ASLEEP, but not so much
that your body functions have to be run by a machine! If your surgeon
puts all of his/her patients under general endotracheal anesthesia for this
operation then it may be a clue that they don't do many of these... and
that their anesthesiologist doesn't do many.
When can I go home after Mini-Parathyroid Surgery (a MIRP
Mini-Parathyroid Surgery, and specifically mini-parathyroid surgery
done with radioguided assistance (the MIRP Procedure) is almost always
done under very mild anesthesia (the patient is given sedatives in
their veins, but they are not put on a breathing machine like a full
general anesthesia). They are asleep for the procedure enough that
they don't feel or remember a single thing, but they are awake enough
to breath for themselves. This means that the patient typically
is awake and alert within minutes of the operation. Usually within 15 minutes they are drinking juice and conversing with their family.
Almost all patients are discharged within 1 to 1.5 hours of the operation. Most go out
for a nice dinner to celebrate!
What happens to my Calcium levels right
after the surgery ?
Your blood calcium level has been high for months or years. It will start
going down immediately after the operation. Your remaining
parathyroid glands have been dormant (asleep) as long as your calcium
has been high. It will take a week or two for these normal
parathyroids to ‘wake up’ and start controlling your calcium like
they are supposed to. If we don’t give you calcium pills to take starting the
evening of the operation, your calcium will go too low, and you will
have symptoms of LOW Calcium. Therefore,
ALL parathyroid patients are put on calcium pills after the operation. You
must take the calcium pills or you will develop symptoms of LOW
calcium during the first 1-10 days after the operation. Having a LOW blood
calcium is more dangerous than a high calcium. This is the most important
information on this page!
The Symptoms of LOW calcium are:
your mouth and lips
Tingling in your
Cramps in your
like 'something is wrong'... feeling poor, confused, and 'in a
What should I do if I have symptoms of
LOW calcium after my surgery ?
If you have
symptoms of low calcium--- take 2 extra calcium pills right away.
How many calcium
pills can you take? Take the 2 extra pills and if you still have symptoms
2 hours later, take 2 more. You can do this until you have taken an extra
10 pills. If you are still having symptoms, you may need to go to your
local emergency room and have them check your calcium. If it is low, they
can give you some calcium in your veins. NOTE: About 1/10 of all parathyroid
patients will have some symptoms of low calcium… even if they take their
pills, so you should expect it
to some degree. But, taking more calcium pills will usually make the symptoms go
Long Will You Be on Calcium Pills?
All parathyroid patients that we operate on are started on 4-5 calcium pills per day. I
recommend Citrical which can be bought over-the-counter at any grocery
store or pharmacy. We provide all of our patients with a box of Citracal.
Calcium dosing schedule following parathyroid surgery is:
4 calcium pills per day for one week
(5 if your calcium is over 12; 6 pills if your
calcium is over 13)
3 calcium pills per day for one week
(4 if your calcium was over 12)
3 calcium pills per day for one week
(4 if your calcium was over 12)
calcium pills per day for a long time.
(3 if you
have severe osteoporosis with T-scores of -3.5 or worse)
Shouldn't patients spend the night after
surgery to monitor their calcium levels?
This is a technique that was standard until the mid 1990's. If your
surgeon is not very experienced with parathyroid surgery, he/she may have you spend the night (or several days!) and measure your calcium
levels every 6-8 hours or so. We
have taken care of thousands of these patients, so we
know what to expect. We give all our patients calcium pills and full
instructions on how many pills to take. This is very simple. Your calcium will drop when the bad
parathyroid gland is removed, so... take some calcium pills for a
couple of weeks. It is really no big deal as long as the patient takes
their pills! We send about 1800 patients per year home an hour or two after the surgery and they begin taking their pills
within 1 hour of leaving the hospital. AND... every patient gets Dr Norman's and Dr Politz's home telephone number
and cell phone number so they can call them directly any time
with any questions. Make sure you know to contact at your surgeon's
office if you have problems with calcium after the operation. In late
2006 we published a study in a major medical journal showing how people react to their
calcium levels after their operation. Endocrine
2007 Mar-Apr;13(2):105-13. This paper includes data on 3000
patients who were sent home immediately after their operation for
primary hyperparathyroidism and started on the calcium protocol listed
above. On this protocol, just under 7% of people got any symptoms of
low calcium and almost all of them did just fine if they simply took a
few more pills (some need as many as 12 pills per day, but don't do
this without talking to your surgeon!). Only 6 people out of 3000 had
to go to the emergency room for IV calcium (in their veins). Not a
single person had to be admitted to the hospital. A link to this very
important paper will be provided here in the near future when this
article is published. Bottom line, you must take calcium pills after
your operation or you will almost certainly get sick... some will get
extremely sick. Take your pills and chances are extremely good that
you will do wonderfully!
Should I take calcium for a few years so
my bones get stronger again ?
If you have decreased calcium in your bones (osteopenia or
osteoporosis), then you probably need to be on calcium for years. Your
body will put calcium back into your bones (reverse some or all of the
osteoporosis) over several years time.
You should also take Vitamin D daily, thus we recommend a calcium
pill that has vitamin D already in it. Studies have shown that AFTER a
parathyroid tumor has been removed, patients can expect their bone
density to RISE about 6-7% per year for several years. This means that
you can expect for your osteoporosis to get better and even go away
after removing the parathyroid tumor. This will NEVER happen without
surgery to remove the bad gland...no amount of Fosamax or any other
drug will reverse the osteoporosis without surgery FIRST.
When can I eat after parathyroid surgery?
Drs. Norman and Politz let all of their patients eat
whatever they want as soon as the operation is over. Many go out for
dinner, and some of the ones that are operated on in the morning go
out for LUNCH! Really... the new operation is not a big deal!
Talk to your doctor about this and get specific instructions.
What am I allowed to eat? Do I have to
avoid Calcium in my diet?
You can eat whatever you want after your
parathyroid surgery. You do NOT have to avoid calcium-containing
foods. Your calcium problems are behind you, and you can have as much
calcium in your diet as you like (see the section above...you should
have lots of calcium in your diet!).
Can't I just wait and see what happens?
Is parathyroid disease really that bad?
Well...The problem with this type of
management of parathyroid disease is that the parathyroid hormone is
working 24 hours per day to take calcium out of your bones. ALL
patients with hyperparathyroidism will get osteoporosis if they wait
long enough. Furthermore, most patients (about 95%) claim to feel a
lot better once the parathyroid tumor is removed...thus you may be
cheating yourself out of a better, more healthy lifestyle. We also
know that long-term exposure to high calcium in the blood increases
the chance of developing breast cancer, colon cancer, and kidney
cancer. It also causes significant heart problems. People with
untreated hyperparathyroidism have been shown in multiple studies to
die several years earlier than they would. This is all covered on our
Bottom line, almost all patients with parathyroid disease will be
better off if they find a doctor who performs LOTS of parathyroid
operations and has been trained in mini parathyroid surgery. Most
people can have their parathyroid problem fixed
in less than 20 minutes if they have the right surgeon with the right
training, experience, and tools! So, with modern techniques and an
expert parathyroid surgeon you can get this problem behind you in one
My doctor put me on Fosamax. Will this
drug help my bones get stronger?
NO, NO, NO. Taking Fosamax, Evista, Boniva,
Actonel, etc will NOT help bones that are being attacked by a bad
parathyroid. There are two important issues here. First, none of
these drugs work on bones in the same way that parathyroid hormone does. It does
not block the effects of parathyroid hormone (PTH). None of these drugs is approved by
the FDA for helping bones in patients with hyperparathyroidism, and it has not been shown in any clinical
trial to help increase bone density in patients with parathyroid disease.
It does not work! Even the makers of Fosamax do not recommend using it for this
Parathyroid hormone is much too powerful for Fosamax to overcome.
Parathyroid patients can take Fosamax for years and their bones will
continue to get thinner! Do not make this mistake! NOTE, these statements
are true for Fosamax, Actonel, Evista, Boniva, Miacalcin, and
others... not just Fosamax. Also, all of these drugs are GREAT drugs
and they help many people with osteoporosis... but they don't work if
you have a parathyroid tumor. They were not designed for this purpose
or this disease.
Why did my doctor put me on Fosamax if
it doesn't work?
The second issue
is that a lot of endocrinologists don't want to send their patients for the
parathyroid operation... so rather than do that, they feel Fosamax
"may be worth a try rather than send you for that big
operation". In a recent study (2000), 55% of endocrinologists
stated that they have had at least one of their patients who was not
cured after having the old-fashioned parathyroid surgery. This fuels their skepticism of parathyroid
operations performed by surgeons who do not specialize in endocrine
surgery. Of course, now that Minimally Invasive
Parathyroid (MIRP) surgery is available,
endocrinologists are rapidly changing their management. Now, 94% of
endocrinologists stated that they would send all of their
parathyroid patients for surgery if the MIRP operation was available.
Its also the operation that 96% of endocrinologists would have
if they had to have a parathyroid operation themselves! (CLICK
HERE to read more about this important study that was published in
the American Journal of Surgery in the Spring of 2003). Bottom
line, the endocrinologist is trying to do whatever they can to help
you and your bones. Some just don't know that these drugs don't work
in patients with hyperparathyroidism, while others think that taking a
simple pill once per week or once per month is worth a try.
Should I be taking calcium pills before
the operation if I have osteoporosis?
Absolutely NOT. If you have
hyperparathyroidism you should NOT take calcium pills. In fact, you
should avoid high-calcium foods (like milk and cheese). Even if you
have osteoporosis, you should NOT take calcium pills or a
multi-vitamin if you have hyperparathyroidism. This will make you feel worse or could actually trigger
a high calcium spike that can trigger a stroke. YES, we have seen
people get a stroke because their doctor told them to take calcium
pills for their osteoporosis even though they had hyperparathyroidism.
AFTER the operation you should take lots of calcium so your bones can
return to normal... but NOT BEFORE!
When do I go back to
see my surgeon, endocrinologist or family doctor after mini-parathyroid
After parathyroid surgery, when do I see
my surgeon again?
When to see your surgeon depends on what type of surgery you had. If
you had the old-fashioned big surgery, you will probably spend a day
or two in the hospital, and then will see the surgeon about one or two
weeks later. If you had a mini-parathyroid operation you will
probably be sent home an hour or two after the procedure and will see
the surgeon or your family doctor post op. Many times, the mini-surgery is so simple
that you don't need to see the surgeon again, and can simply follow up
with your family doctor or endocrinologist in a week or two. You just
peel off the small Band-Aid one week after the operation. No stitches,
After parathyroid surgery, when to I see
my endocrinologist or family doctor again?
Again, the old-fashioned big parathyroid
operation will often require more follow up visits. The wound is
and has much more potential complications, thus more visits to the doctor
are often indicated. If you have the big operation, then you will
see your endocrinologist or family doctor several weeks after your
first visit to the surgeon after the operation. If, however, you
have a mini-parathyroid operation, you may be able to skip one or more
doctor visits (mini-operation usually equals mini-problems!) and proceed
directly to the endocrinologist or family doctor a week or 10 days
after the mini-operation. Your surgeon will make these arrangements
for you on a case-by-case basis. Of course, this is the kind of think
you need to discuss with your surgeon and he/she will customize this
process to what is best for YOU.
What happens at this doctor visit after
the parathyroid surgery? Does anything in addition to the calcium
level need to be checked? Does the patient need an
How you are treated after parathyroid surgery depends on whether you
had mini-surgery or the old-fashioned surgery. Those who get a
mini-operation and go home an hour later can have a post op visit any
time within the first 2-3 weeks. There are no stitches to take out...
nothing to do except get your blood tested for calcium and PTH. It is
VERY simple! After that, there is nothing else to be done. Once cured,
almost always cured (less than 1% chance of ever getting this disease
again in your lifetime). The only issue left is deciding on how much calcium to take
daily for years to help the bones get strong, and whether or not to
put a patient on a bone-increasing drug. If you have an endocrinologist he/she will probably be the
one that follows your osteoporosis for several years to document that
your bones are getting stronger... and many family practice and
internal medicine doctors know this well so you may not need the
endocrinologist. You do NOT have to get your calcium and PTH
checked every year once you have proven that it has been cured.
If I go to Tampa for my surgery, what do
you do about my wound and stitches?
Drs Norman and Politz use many
modern surgical techniques, including the
most modern sutures. All the sutures we use are absorbable, so the
body will absorb them and they disappear in about a month. For the skin,
we use a suture that is thinner than a human hair, and the wound is
closed in a manner that allows all the stitches to be on the INSIDE...
thus there are NO stitches to take out. This is a "Plastic
Surgery" type of closure and it results in a very small, often
un-noticeable scar that is about 1 inch in length. You go home with a
small "steri-strip" bandage as the only bandage...like a 1
inch long piece of white tape over the wound. You can get this wet and
shower/swim within 24 hours. Then you simply peal it off 1 week after
the surgery. If you weigh less than 120 pounds, the wound is usually
about 3/4 inch. You will be amazed at how simple this can
be! Please watch the movie of the MIRP operation to see more about the
wound and the stitches...Click
Here to watch the movie.
I have a thyroid
Can my thyroid nodule be removed during a mini-parathyroid
Can this be done through the same small 1 inch incision?
|Is it true? I can have my thyroid nodule
removed at the same time as a mini-parathyroid operation?|
The answer to this is YES--if you have an
experienced parathyroid surgeon. The facts are that about 80% of
patients will have some form of thyroid nodule by the time they are 60
years old. This number increases to about 90% when the patient is 80
years old. At least 99% of these are simple, benign nodules. However,
sometimes these nodules should be biopsied or removed. Thus it only
makes sense that your parathyroid surgeon should be familiar with all
types of thyroid nodules and know what to do if certain types of
thyroid nodules are found. During 2007, Dr Norman
performed 1,785 parathyroid operations. Of these, 409 (22.8%) had a
thyroid nodule removed or biopsied during the mini-parathyroid
operation. None of these patients required a larger incision...this
can still be done through an approx 1 inch incision if your surgeon
does this type of operations all the time. On two occasions, thyroid
cancer was found and the patient required a complete removal of the
thyroid gland (these two patients needed a larger incision to cure the
thyroid cancer). Only six patients who had a thyroid nodule or a
portion of one thyroid lobe were kept in the hospital overnight.
Mini-surgery techniques and virtually bloodless surgery allows
virtually all of these patients to go home within 2.5 hours (about 30-60
minutes longer than if they did not have a thyroid nodule
removed). The bottom line is this: the parathyroid glands are
located BEHIND the thyroid gland, so it is good and acceptable
practice to evaluate the thyroid at the time of parathyroid surgery.
Your surgeon should be able to do this, and he/she should be able to
tell you what they plan on doing about any thyroid nodule they find
during your parathyroid surgery. The chance of cancer is very low, but
these nodules should usually be evaluated and not ignored. It is simple, adds
only a few minutes to the overall operation, and will allow the
nodule to be removed so it doesn't have to be worried about any
longer. Again, talk to your surgeon about your thyroid and figure out
what he/she plans to do if they find a thyroid nodule. However, let us
say this in closing... it is NORMAL to have a thyroid nodule. MOST
humans with parathyroid disease have at least one thyroid nodule, thus
you are not different from MOST patients with parathyroid disease. DO
NOT make a big deal about your thyroid nodules. Should it be looked
at??...YES. Should it be removed??... not necessarily (MOST do
NOT need to be removed). Is it a big deal?... not really. Trust
your surgeon's experience on this topic.
|My doctor says I can't have a mini
parathyroid operation because I have a thyroid nodule.|
This is true for almost all surgeons.
However, this is NOT true for some parathyroid experts. For our last
5000 patients, about 22% have had a thyroid nodule removed during the
mini parathyroid operation. This added procedure adds about 2 minutes
to the typical parathyroid operation. Some peripheral nodules can be
removed in less than 1 minute, while some large central nodules will
take 5-10 minutes to removed. We almost never increase the size of the
incision. In general, a thyroid nodule is EXPECTED in patients with
parathyroid disease and thus it is so routine that it should cause
your surgeon little or no concern. If your surgeon is making a big
deal about your parathyroid operation because you also have a thyroid
nodule, then this is a sign that they aren't as experienced as you may
want. This is not a big deal, do not let your doctors make a big deal
about it. Get it addressed, get the nodule removed if necessary, but
geeezzze, don't let them tell you that you have to have a big
old-fashioned parathyroid operation because you have a thyroid nodule!
read more about thyroid nodules, go to our sister website EndocrineWeb
(click here). This is the 5th most visited medical website in the
world with over 3.7 million page downloads per month.
This page was last updated: 11/26/2011