Aim: To determine the impact that Minimally Invasive Radioguided Parathyroid Surgery (MIRP) is having on the way endocrinologists treat hyperparathyroidism.

Methods: The membership of the American Association of Clinical Endocrinologists was surveyed by mail regarding physician practices and surgical referral patterns for parathyroid disease. The survey utilized a visual analog scale (VAS) and multiple-choice questions. The associations were tested for statistical significance using Chi-square and logistic regression. Data are mean±SEM.

Results: The 788 responding endocrinologists had been practicing for an average of 17 years. They referred an estimated 63% of all patients with parathyroid overactivity for operative treatment, and typically utilized parathyroid localizing studies prior to surgical referral (Sestamibi scan most commonly).  80% indicated that the availability of mini parathyroid surgery (MIRP) would (or has already) increase the number of patients referred for parathyroid surgery, to near 95% of all of their patients with parathyroid disease. Endocrinologists identified parathyroid symptoms, calcium homeostasis, bone density, health status, risk of general anesthesia, and patient age as the most important factors in their decision to send their patients for a parathyroid operation. By far the most important factor in deciding whether to send a patient for a parathyroid operation was the availability of an expert parathyroid surgeon, and their ability to perform a mini-operation.

Endocrinologists also indicated that the availability of Minimally Invasive Radioguided Parathyroid surgery (MIRP) would change the extent and duration of their preoperative workup of their parathyroid patients they would send for surgery (p<0.0001). In other words, they overwhelmingly stated that if their patients could have a mini parathyroid operation (MIRP) rather than a standard parathyroid operation, they would order fewer tests and send the patient for an operation much sooner.  Younger endocrinologists were statistically more likely to refer patients for mini surgery (p=0.001) sooner and thus alter the extent of the preoperative work-up for these parathyroid patients (p=0.03). 

More than 50% of endocrinologists stated that they had one or more patients who underwent a standard parathyroid operation in the past who had a significant complication, or who were not cured by the operation.  These endocrinologists were more anxious to send their patients for a minimal parathyroid operation (p=0.02). 

Finally, when asked if they had to have a parathyroid operation themselves, 96.5% of all endocrinologists stated they would have a Minimally Invasive Radioguided Parathyroidectomy (MIRP) rather than a standard operation (p<0.0000001).

Conclusions: These data confirm the clinical impression seen by the authors (Dr. Norman, et, al.) that mini parathyroid surgery lowers most endocrinologist's threshold to refer parathyroid patients for surgery. Moreover, having mini parathyroid surgery available for their parathyroid patients is very likely to decrease the number of tests these doctors order. The availability of mini parathyroid surgery will also decrease the time from diagnosis to referral--so the amount of complications such as osteoporosis will be less. Because of the perceived shortcomings of traditional parathyroid surgery, endocrinologists are rapidly embracing minimally-invasive parathyroid techniques validated by disciplined outcomes research.

Update, October, 2010.  A more recent poll shows that 99.1% of endocrinologists would travel to another state to have surgery by an expert parathyroid surgeon rather than have their operation by a local general surgeon. In fact, 86% said they would travel to another state to have this operation by an expert rather than have the operation performed by the surgeon they send their patients to! What does that tell you about the tricky nature of this operation? They wouldn't let their local general surgeon or ENT surgeon do their parathyroid operation. We can't operate on everybody, but please, find an expert parathyroid surgeon. We are tired of the 3-4 calls we get every day from people who were operated on by a surgeon who told the patient he/she could do this operation because they had a scan that was positive. Folks, its not about the scan, its about the skill of your surgeon. Please be smart out there!