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 Parathyroid
disease (Hyperparathyroidism) is quite simple in the vast majority of
patients. Most patients will have only one parathyroid tumor, however,
about 25 to 30% will have more than one parathyroid tumor. Since your
surgeon can't tell before the operation who will have one parathyroid tumor and who will have
two (or even three), he/she should look at all four parathyroid glands
during your operation. Usually these parathyroid tumors about the size of an
olive or a grape. Parathyroid tumors are benign (non-cancerous) which we call an
"adenoma".This page assumes you know some basic
information about parathyroid disease.
 You
should already know that all humans (dogs, cats, horses, cows, deer,
antelope, pigs, elephants, giraffes, etc, etc, etc) have 4 parathyroid
glands. All mammals have 4
parathyroid glands.
You
should already know that hyperparathyroidism is a disease caused by the
over-production of parathyroid hormone (PTH). It is this hormone that
circulates in the blood removing calcium from the bones and puts the
calcium into the blood. It is the high calcium in the blood that causes
all of the symptoms and problems. The high calcium in the blood came
from the bones--the calcium is being leeched from the bones.
You
should already know that the majority of cases of parathyroid
disease are caused by a single bad parathyroid gland... a benign tumor
called a "parathyroid adenoma" This tumor will continue to
grow and make your disease worse and worse until it is removed.
Parathyroid adenomas will NEVER go away on their own. They will NEVER
decrease in size on their own. They are TUMORS that must be removed.
They are NOT cancer, they are benign tumors that make uncontrolled
amounts of hormone. Click here to see
lots of pictures of parathyroid adenomas.
This
disease is very simple and very easy to fix in almost all patients. Be
careful if your doctors tell you this is hard and dangerous to fix. Things have changed
over the past 10 years! If you get an expert surgeon,
hyperparathyroidism is almost always very easy to cure.
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Most People Have Just ONE Bad Parathyroid -- But
be careful!
In Review: About 70-75% of patients with
primary hyperparathyroidism (parathyroid disease) have just one parathyroid gland that has grown into a tumor.
This means that the other three
parathyroid glands are normal. The single bad parathyroid gland is
called a "parathyroid adenoma". This is a benign tumor
-- get a surgeon to remove it and you are cured. But
be careful, if your surgeon takes out the one tumor and quits the
operation without looking at the other 3 parathyroid glands you
may not be cured. There is no way to determine who has only one
parathyroid adenoma prior to the operation. No scan can tell you
this (please, stop relying on the scans!). If your surgeon removes
only one tumor and quits the operation you may be one of the
25-30% who have more than one parathyroid tumor and then you won't
get better, and you won't feel better (and you will need a second
operation to remove the second parathyroid adenoma). This concept
is illustrated beautifully in the video of Dr
Norman performing a parathyroid operation--the scan on this
patient shows one
tumor but he had two! If
your surgeon says he/she will "measure the PTH hormone to see
if it drops by 50% or more and this will tell me that there are no
other tumors present", then be careful. We NEVER use this
test because it takes at least 45 minutes to run and it is inaccurate
at least 15% of the time. Can you name a test that we use
for ANYTHING in life that is inaccurate 15% of the time? There is
no other test in medicine (or engineering, accounting,
mathematics, physics, chemistry, or any other aspect of life) that
is wrong 15-20% of the time. So be careful if your surgeon tells
you that he/she will rely on this test to determine if you are
cured. Just ask them--and have them look you in the eye when they
answer: Does this "Intraoperative PTH assay" test always
work? Have you ever seen this test not work? Has this test ever
made you do something during the operation that you regret? Has
this test ever made you hurt a patient because it was wrong?
Folks, be careful relying on a surgeon who relies on a test that
is wrong so much of the time. We do thousands of parathyroid
operations per year--if this test worked we'd use it. Be smart out
there! We operate on several patients every day that were not
cured because they had an inexperienced surgeon operate on them
previously who used this test. |
THE PROBLEM: A recent telephone survey completed in
June 2008 of 400 patients with primary
hyperparathyroidism who were scheduled to have surgery at the Norman
Parathyroid Center showed that 82% believed that they have more than one bad
parathyroid gland. Yes, 82% think that they are one of the 25%. How
can it be that so many people think they have a more complex disease than
they do? How are they getting their information? How
are they being informed that parathyroid surgery is dangerous and that
they will have to have a big 3-5 hour operation to fix it... and possibly
not even fix it? Who tells everybody the wrong information? Who tells them
that they have 4 bad glands when they clearly do NOT? Who is confusing these patients?
Side Note so we don't confuse you too:
Even the 1.5% of patients with 4-gland disease can have mini parathyroid surgery at
the hands of some expert surgeons. Mini parathyroid surgery is
NOT only for those with a positive scan if you have an expert
parathyroid surgeon who does many parathyroid operations. The biggest
mistake we see (besides not diagnosing parathyroid disease correctly) is
that patients will get a poor quality sestamibi scan which doesn't show
a tumor and their doctors will tell them that they likely have four bad
parathyroid glands (hyperplasia), and therefore the operation is more
difficult and can't be done as a mini operation. It depends on the
surgeon. This is not true! We do mini-surgery on 100% of
patients regardless of the scan results. Geeezeee, folks, stop getting
scans! Scans are wrong more than they are right!
Here
are a few facts about parathyroid surgery and the differences between the
70% of patients with one parathyroid tuomr vs. the 30% with two
parathyroid tumors, and
the 1.5% with 4 bad glands.
 | We no longer perform one-side operations. We have learned from tens
of thousands of patients that there is simply no way to determine who
has more than 1 parathyroid adenoma without looking (and evaluating
the function) of all four glands. However, since we have done this so
many times, evaluating all four glands typically takes us between 14 and 21 minutes (average is
18.2 minutes). Watch
the video that we have online--this video shows the removal of
2 parathyroid tumors and the biopsy (evaluation) of the other 2
normal glands--and the entire operation takes less than 13
minutes. |
| Patients with a single adenoma usually start getting
relief of their symptoms in 1-10 days where as those with 4-gland
hyperplasia usually take a week or two before they start feeling
better. (Note: All patients can take as long as 3 months before they
feel the full benefit of parathyroid surgery. However, MOST patients
feel dramatically better by 2-4 weeks post-op). |
| The bottom line -- it doesn't really matter if you have one bad
gland, two bad glands, 3 bad glands, or 4 bad glands if you have an experienced surgeon. The operation to fix 4 bad glands is
straightforward and
very successful if you have an experienced surgeon. The incision should be
the same whether your surgeon is going to look at all four glands or
not... if they say they will look at one parathyroid tumor and them
measure the parathyroid hormone in your blood to see if there are
other bad glands present... and if there are he/she will make the
incision larger... then know you do NOT have an expert parathyroid
surgeon. |
| Also... avoid the surgeon
that says "you have a negative scan so that means you probably have 4 bad
glands--I need to remove all 4 and transplant one in the arm". If
your surgeon says this, then you should instantly, and without delay,
get up and run out of the office! This is NOT correct.
Transplanting parathyroid glands into the arm of a patient should be
used only for patients who have kidney failure and are on dialysis.
This should never be done for patients with primary
hyperparathyroidism (the disease that is discussed throughout this
entire website). If any of your doctors tell you that they think you
have 4 bad parathyroid glands (hyperplasia) because your scan is
negative, then know instantly that they know very little about this
disease and they have not seen more than a few (or any?) parathyroid
operations. There is NO DIFFERENCE in the the number of parathyroid
tumors in patients with negative or positive scans. Again folks,
stop getting scans. They are wrong more than they are right. And, RUN
FAST, if any doctor tells you that you probably have 4 bad glands
because you have a negative scan. Can we make this any clearer? There
is no gray area here! |
Why Do So Many Parathyroid Patients Think They Have 4 Bad Parathyroid
Glands?
Where Do Patients Get the Bad Information? Who is
Misleading Patients into Thinking they Have 4 bad Glands and Then Tells
Them They
Can't Have Mini Surgery?
Well,
the answer to this question is simple, but may not be politically correct.
We will let the facts speak for themselves.
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Most patients are treated by doctors who see primary
hyperparathyroidism rarely. |
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Most endocrinologists know very little about this
disease. In fact, about 80% of our patients say they know more about
hyperparathyroidism than their endocrinologist. If you are reading
this page, then almost surely you will know more about
hyperparathyroidism than most endocrinologists. |
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Doctors who rarely see parathyroid disease will
occasionally tell
patients that surgery is dangerous and risky. It may be in their
neighborhood because they see it rarely, but it is not dangerous and
risky everywhere! If your doctor says parathyroid surgery is dangerous
and risky, go find a doctor who does this routinely and tells you that
it is easy. |
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Most endocrinologists spend the vast majority of their
day taking care of diabetes. Secondly they will see patients with
thyroid problems. Most endocrinologists see less than 1 parathyroid
patient per month (about 5-15 per year in a recent survey).
 |
Many endocrinologists will take an interest in
your parathyroid disease and can be very helpful to you. If your
endocrinologist is interested and knowledgeable, they can be a
very wonderful asset. However, if they are not up on all the
latest medical literature, and they don't know how good their
x-ray department is, then they can mislead you. If they tell you
you can't have mini surgery because your scan is negative--then
its up to you to educate them! This is not true for all surgeons.
Its up to the surgeon, not up to the x-ray! |
| It is very important for you to understand that
your endocrinologist (as wonderful as many are) is not a surgeon
and therefore very few have ever seen a parathyroid gland in his/her life.
Chances are that he/she has never actually seen a parathyroid
operation. Never. So the lesson here is this... be careful
of advice given to you about an operation by a doctor who has
never actually seen the operation they are talking about. Clearly
this make sense to you... and it should. All endocrinologist will
tell you that you must find an experienced surgeon, and they will
all tell you that the more experience a surgeon has performing
parathyroid surgery the better. This is great advice. But if they
tell you that you have to have all four removed because your scan
is negative... that is simply not true. Get up and walk out. Don't
put up with a doctor who speaks as an expert but is wrong. Only
1.5% of patients with a negative scan have 4 bad glands! |
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| Patients are sent for ultrasound scans, CT scans, and
MRI scans in an attempt to locate the one bad gland--the adenoma. CT
scans and MRI's are almost always negative (don't get one--you will be
wasting your time--only 5% are positive and thus 95% of the time they
are a waste of time and money). They will almost never show
the adenoma. Ultrasound scans are usually negative if they are
done by a technician at a radiology department (they find the
parathyroid tumor only about 17% of the time... recent data in
publication by Dr Norman who reviews over 1000 parathyroid ultrasound
scans per year). The only ultrasound
scans that are usually worth a hoot are those that are actually done by your
endocrinologist in his/her office or by your surgeon in his/her office
(even still, at least 25% of these are not positive--deep upper
parathyroid glands simply cannot be seen on ultrasound, just like you
can't take a picture of Saturn with your cell phone camera). If you are sent for an ultrasound
scan at some radiology place... you may want to tell your doctor "no, it is not
necessary", and ask to discuss the merits of this test further.
If they are worried about THYROID problems also, then the ultrasound
can be useful. Discuss this with your doctor and see what
the purpose of the ultrasound is going to be. If your
doctor orders a CT scan or MRI before you ever see a surgeon, then you
should just shrug your shoulders and print this page and take it to
them. We cannot think of any reason that any
patient should have a CT scan or MRI on a patient with hyperparathyroidism prior to an
operation. This should NOT be done. If you are going to be our
patient, do not get any scans... we won't look at them. The underlying
theme of many pages on this website is this: Stop getting scans...
scans are wrong more than they are right.
| A negative scan does
NOT mean you have 4-gland hyperplasia, it usually means you had an unnecessary x-ray. Many of you reading this page know
this to be true! If we could teach all the doctors out there this
one fact we'd consider ourselves very successful! |
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All patients should get a sestamibi scan
(however, it probably should be ordered by the surgeon and not the
endocrinologist---but we can't fight this fight... most
endocrinologists send their patients for a sestamibi scan... we wish
they did not-- since it should probably be done by the surgeon;
possibly done only once on the morning of the operation (which is what
we do).
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About 60% of sestamibi scans performed in the US
are done in such a poor manner that they will be interpreted as
"Negative" even though they would be positive if they
were done better. Read this last sentence again and let it sink
in. OUCH! |
| When a scan is done poorly, it will not show the
adenoma. At our clinic, over 90% of scans that are
"negative" at some other hospital become
"positive" and show the adenoma when we do the scan
correctly. Read more about Sestamibi
scanning here. About 81% of all patients that travel to
Tampa for surgery have had a NEGATIVE sestamibi scan somewhere
else. Please, don't waste your time and money on a scan that will
be worthless if you plan to come here! |
|  Our data on over
21,500 scans performed on our patients before they were sent to us
between 2003 through 2011 shows that about 80% are read as negative when they are
really positive when the scan is done correctly! If your scan
looks like a couple of out-of-focus blobs... then its probably not
a very good quality scan.
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| Remember... a negative scan is wrong 100% of the
time. A positive scan is wrong 60% of the time. Look folks, forget
about the scans! Scans are wrong more than they are right,
so please, do NOT worry or be concerned about your scan.
Better yet--DON'T GET A SCAN! |
| Finally, if you watched the movie, you will
realize that even when the scan is positive, 20% of patients will
have a SECOND tumor that does not show on the scan. Scans are over
used and their results are way over emphasized. Stop worrying
about the scan. Your scan, regardless of who does it will be wrong
more than it is right. It's not about the golf clubs, its about
the guy swinging the clubs! |
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You Need to Look at Your Own Sestamibi Scan!
YOU should look at your sestamibi scan. If it is not clean,
crisp, and in focus, then you are getting a scan that is not as
good as it can/should be. You as a
patient with no medical training should be able to look at your
sestamibi scan and clearly see your head, neck, shoulders,
salivary glands, thyroid gland, etc. Nobody should have to tell
you what you are looking at. It should be very clear and in focus
and clearly show your head and shoulders. If it is blurry and
looks like a bunch of black blobs and black blurs then you may
have wasted your time. You as a novice may not see the parathyroid tumor (that
takes a LOT of practice), but you should be able to see your upper
body in a clear and crisp picture. Again... blurry blobs =
terrible technique, can't rely on the results... be glad you aren't
the one paying for it!. |
Even many large university hospitals do not do sestamibi scans
well. In our recent study we found that university scans were NOT any
better than those done in community hospitals... that many of them were done
in a poor, or even worthless manner. Again, a NEGATIVE SESTAMIBI SCAN DOES
NOT MEAN YOU HAVE 4-GLAND HYPERPLASIA... It means that 1) the scan is very
poor quality, or 2) the parathyroid tumor is located exactly where it is
supposed to be--right behind the thyroid and the scan can't see
it--because the thyroid is in the way. The scan is JUST A TOOL. Don't get hung up on
this scan... it's just a tool that your SURGEON can use to help find the
gland when he/she operates. Again, if you don't get a scan, you won't be
confused by it. If you want to come here for your operation, then by all
means, don't get a scan--we won't even waste one minute of our time
looking at it.
If your doctor tells you
parathyroid surgery is complex and dangerous, you may want to find one
that doesn't say this! Would
you get on an airplane if the pilot told you it was complex and dangerous
to fly? Would you fly on an airplane if the pilot only flew this type of
airplane a couple of times per year? Parathyroid surgery is not
risk free, but it should be very straightforward, very predictable, and
extremely low risk (near zero risk). If
your surgeon can't tell you with a high degree of certainty which parathyroid
gland is bad and what they intend to do about it before the operation...
you may want to find a surgeon with more experience.
If your surgeon is not performing parathyroid surgery at least twice per week,
you will not have the same results as one that is doing this many (the
more he/she does is usually much better for you). If your surgeon is going to put a drain in your neck to
drain out any blood after the operation... well, you may want ask why this
is being done. If your
surgeon tells you that you have 4 bad glands because your scan is negative
then this is a problem and you do not want this surgeon. If your surgeon tells you that your
operation could possibly take more than 2 or 3 hours... well, you may want
to find somebody that does this operation more often. If your surgeon tells you that you have to spend the
night in the hospital, well, you may want to ask why, since this is almost
never necessary. There is no other operation in the world that is
influenced by surgeon experience as much as parathyroid surgery is. For an
expert... it is very simple, straightforward and safe operation. Do not be
afraid of parathyroid surgery if you have an expert surgeon. Feel good about your surgeon, and then
relax, he/she will remove the tumor and put this behind you.
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