Surgery
is the only way to treat parathyroid disease...There are no medications or
pills that work to cure parathyroid disease. The parathyroid tumor must be
removed by a surgeon. As soon as the parathyroid tumor has been removed,
you are cured! It is very likely this will change your life! If you
have hyperparathyroidism you need to have parathyroid surgery. BUT IT IS
EASY if you have an expert surgeon!
Note:
We performed a MIRP mini parathyroid operation LIVE on the
Internet for you to watch.
Click
Here to watch a movie of this operation as it occurred live June 14th
Since 1925, the standard treatment for parathyroid
disease (primary hyperparathyroidism) has been to surgically remove the
parathyroid gland (or glands) which are overproducing parathyroid hormone.
Remember, this is a
hormone problem, so the goal is to remove the source of the excess
parathyroid hormone (remove the bad parathyroid gland, leave the normal
parathyroid glands). Again, the concept is really quite simple: Find
which parathyroid gland has become a tumor and is making too much
parathyroid hormone and take it out...leaving the other normal
parathyroids alone. The normal parathyroid glands will take over and you
will be cured. You don't need all four parathyroid glands.
The 'standard parathyroid operation' has
not changed since its invention in 1925, and is performed by putting
the patient to sleep under general anesthesia. An incision is made in the neck,
the muscles of the neck are retracted sideways and the thyroid gland is loosened
up and moved aside to allow the surgeon to identify the four parathyroid glands which reside moderately deep in the neck
behind the thyroid. Patients
having a 'standard parathyroid operation' are always hospitalized over night, and
sometimes as long as a two or even three days. The incision for the standard parathyroid operation has to be made of sufficient length to allow the surgeon adequate exposure of the numerous important structures
within both sides of the neck, and thus it is typically six or seven (and even up to 10) inches long. These wounds eventually heal quite
nicely but you will have a big scar on your neck forever. The picture on the left shows the incision needed to expose the
parathyroid glands on both sides of the neck when doing the old-fashioned
parathyroid surgery. This is the operation that your doctor may be reluctant
to send you for--often for good reason. The editor of this site believes this
operation should almost never be done in this fashion, however, this is the operation you
will probably get if you don't go to a parathyroid specialist. This
operation is a very out-dated. There is better technology available. You
can do better.
Because of the numerous small nerves and other important structures within the
neck which reside around the parathyroid glands, the 'standard'
parathyroid operation can be technically challenging and has the best
results when performed by experienced endocrine (parathyroid) surgeons or surgeons with extensive head and neck operative experience.
Numerous publications in medical journals have shown that the
success rate following parathyroid surgery is directly related to
the number of parathyroid operations the surgeon has performed (we
have a page devoted to cure rates).
This is what you will find when you read about parathyroid surgery in
every text book, or on any web site on the Internet...the experience of
the surgeon is more important than anything else. The cure rate
for a standard parathyroid operation performed by a general surgeon is
about 85 to 90%. Endocrine surgeons have a cure rate between 93 and 97%. On other pages you will see that newer forms of mini
parathyroid surgery have cure rates of 99% or better in most patients.
During the standard operation, the surgeon must identify all four parathyroid glands and
remove whichever one(s) is enlarged. As covered in the section describing
hyperparathyroidism in detail, approximately
95 to 96% of the time there is one large parathyroid gland (an adenoma
which is a benign parathyroid tumor) and three normal
parathyroid glands. In this situation the one large gland (the
parathyroid adenoma) would be removed leaving the three normal ones to function in a normal fashion indefinitely. If the surgeon found all four
parathyroid glands to be enlarged (found in only 4-5% of patients and
called: parathyroid hyperplasia), he/she would typically take out 3 or 3-1/2 of these glands leaving some parathyroid tissue behind to function normally in the future. In experienced
hands (endocrine surgeons who have done over 250 of these operations), this
big old-fashioned operation has a
cure rate of about
94-95 percent, but can be as low as 85% for surgeons who operate on
parathyroid patients infrequently. You MUST pick your surgeon
wisely.
To complete
a 'standard parathyroid operation' safely with a high rate of success,
the operation occurs on both sides of the neck (a standard bilateral
neck exploration), and is always performed using general
endotracheal anesthesia. General anesthesia, however, is extremely
safe for nearly all patients. Because of the concern over general
anesthesia in some elderly patients, and concerns about a 8 inch (or
larger) incision on the neck, and the risks of damage to the nerves to the voice box, some
endocrinologists and family doctors elect not to send patients for this operation until
the patients develop SEVERE hyper-parathyroid symptoms or have a significant loss of bone
density (osteoporosis). This means of management of parathyroid
disease may or may not be in the best interests of the patient based
upon the potential risks (small, but real) of the standard
parathyroid operation. You need to discuss the pros and cons of routine
parathyroid surgery with your endocrinologist and weigh the risks of surgery versus continued
monitoring of your
body calcium
stores and your bone density. NOTE:
Minimal parathyroid surgery is dramatically
changing the way endocrinologists treat parathyroid disease, sending
almost all of their patients for surgery. Read a recent survey of
endocrinologists (Click Here) to see
how 98% of them would have a minimally invasive parathyroid
operation instead of a standard
parathyroid operation. The picture on the right shows how small of
an incision is made for a MIRP minimally invasive parathyroid
operation- it is a 1-inch incision (or less!) and usually takes less than 20 minutes
to perform. Again, if you can have a 20 minute out-patient procedure to
CURE your parathyroid problem, then it almost always makes sense to get
this done instead of waiting to develop kidney stones, osteoporosis, or
severe symptoms. Thus, you need to read more on this web site about your
surgery options and the difference between the old-fashioned operation and
mini-parathyroid surgery.
This
big-old-fashioned parathyroid operation typically takes 2 to 4 hours to
complete (depending on the case and the skill of the surgeon), and 5 to 15 percent of patients will not be cured after
the operation. As many as 4 percent will have a serious complication
depending on your surgeon's experience. You can expect to spend 1 to 3
nights in the hospital. THIS IS THE WAY IT HAS BEEN DONE SINCE 1925. FOR
MOST PATIENTS--THIS
IS NOT THE WAY IT SHOULD BE DONE ANYMORE. THERE ARE NEW AND BETTER WAYS TO
DO THIS OPERATION! If your surgeon discusses having surgery this
way, you may want to find an expert surgeon (endocrine surgeon) who
performs parathyroid surgery on a more frequent basis. HOWEVER, parathyroid disease is a rare
problem, so MOST surgeons only know how to do parathyroid surgery the
old-fashioned way. Tell your endocrinologist and/or your family doctor
that you want a surgeon that is an expert in parathyroid surgery and that
you do not want the same general surgeon that they send their gallbladder
and hernia surgery patients to. Ask for an endocrine surgeon.
Parathyroid.com EDITOR'S NOTE: The
standard operation for parathyroid disease as discussed on this page
can be avoided for most patients with primary hyperparathyroidism. It is a safe and
effective operation, but typically is a MUCH larger and more complex
operation than is needed for most patients. Since the
invention of Minimally Invasive Parathyroid surgery in the early and
mid 1990's, it has been documented that minimal parathyroid surgery has a cure rate that is
higher, a complication rate that is about 1/4 or less, and it can be
done with local anesthesia or "twilight anesthesia" typically in less than 20 minutes.
VIRTUALLY ALL parathyroid patients can have a MIRP mini-parathyroid operation at
some centers performed by some surgeons. NOTE: Even the
standard operation should NOT be done in the old fashioned way...there are
new techniques used by the best parathyroid surgeons that make this
operation smaller and more successful (measuring hormone levels during the
operation, etc). There are several pages on minimal parathyroid surgery on this web
site, including surveys from endocrinologists and summaries of
journal articles showing statistical evidence of the benefit of
minimal parathyroid surgery. Before you have surgery, make sure you
understand your options!
Footnotes for journal articles examining the success
rate of parathyroid operations based upon how often the surgeon does this
tricky operation:
1) Chen H, Zeiger M, Gordon T, Udelsman R. Parathyriodectomy in Maryland,
Effects of an endocrine center. Surgery 1996;120:948-53.
2) Sosa JA, Powe NR, Levine MA, et al. Thresholds for surgery and surgical
outcomes for patients with primary hyperparathyroidism: A national survey
of endocrine surgeons. J Clin Endocrinol Metab 1998:83:2658-65.
3) McHenry CR. Patient volumes and complications in thyroid surgery.
British J Surgery 2002;89:821-823
4) Mittendorf EA, McHenry CR. Complications and sequelae of
parathyroidectomy and an analysis of surgeon experience and outcome.
Surgical Technology International XII. 2003:152-157.
5) Norman J, Politz D. Failed parathyroid surgery: The high personal and
financial cost of surgeon inexperience. Manuscript in press, 2006.
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