Exploratory Parathyroid Surgery.
Parathyroid surgery is introduced here. The
standard 'big' parathyroid operation is out of date and requires the surgeon to
"explore" your neck to find your parathyroid tumor. Nobody should have this large old-fashioned
parathyroid operation. Virtually all patients should have a
mini-operation, even if their x-ray scans are negative.
is the only way to treat parathyroid disease (hyperparathyroidism). There are no medications or
pills that work to cure or treat parathyroid problems or high calcium. 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. If you have an expert
surgeon this operation should be very easy.
Note: We have a mini-parathyroid
operation for you to watch. Everybody should have a mini-operation.
Here to watch a movie of this operation as it occurred live (no
editing-takes 13 minutes).
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. A large 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
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 never be done in this fashion, however, this is the operation you
will probably get if you don't go to a parathyroid specialist. The key
words to knowing you are going to have this operation is the surgeon will
say he/she will "explore" for the parathyroid glands. This
operation is a very out-dated. There is better technology available. You
can do better. Keep reading--and remember--exploring should be done
on vacations in the mountains, not inside your neck!
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% when performed through the big incision you see above and
at the bottom of this page. 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--depending on the skill and experience of your surgeon.
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, the
vast majority of time there is just 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
parathyroid glands to function in a normal fashion indefinitely. If the surgeon found all four
parathyroid glands to be enlarged (found in only 2-3% 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
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. 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
stores and your bone density. NOTE:
Minimal parathyroid surgery has dramatically
changing the way endocrinologists treat parathyroid disease, sending
almost all of their patients for surgery immediately. 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 and usually takes less than 20 minutes
to perform. Again, if you can have a 15-20 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. When we do this operation, it typically takes
less than 17 minutes and has a cure rate near 100%. Patients go home
within a couple hours. Keep reading...
big-old-fashioned parathyroid operation typically takes 3 to 6 hours to
complete (depending on the case and the skill of the surgeon), and 10 to 15 percent of patients will not be cured after
the operation. As many as 5 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 they did it in 1925. FOR ALMOST
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, and "exploring" for your parathyroid glands, you may want to find an expert surgeon (endocrine surgeon) who
performs parathyroid surgery on a more frequent basis. However, parathyroid disease is
an uncommon problem, so almost all surgeons only know how to do parathyroid surgery the
old-fashioned way--the way they saw it done years ago when they were
learning. 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 breast biopsy 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 all patients with primary hyperparathyroidism if they have a
surgeon who is an expert in parathyroid surgery. The old fashioned parathyroid
operation is a safe and
effective operation, but typically is a MUCH larger, more complex
operation than is needed. The chance of something bad happening
is much higher--again, due to surgeon experience. Ask your doctors, they
will all tell you to go to the surgeon that does the most--because bad
things can and do happen. 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 "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!
Dr Norman... Please put this on your Website. I had my parathyroid operation in
December 2008 by some other surgeon and not by you... and this is
what happened to me. I
first went to a surgeon that said the negative parathyroid scan meant that there
was no tumor. I am 35 years old, well educated, had major bone pain
for about 8 months, (crippling at times) and other typical symptoms.
My calcium levels were 13.6 with a PTH of 178. I'm no
doctor, but I KNOW this is severe hyperparathyroidism. I realized I
knew more about this than the first surgeon so I went to another
surgeon. I had another scan done; this time it showed a faint
object, so the surgeon decided to go in and "explore" for
my parathyroid glands. He was going to "try" a mini
operation first, and if he could do it, he would.
This photo shows what the outcome was. The operation took almost 4 hours and I spent almost 2 days in the hospital. The
incision makes me sick when I see how small and quick your
parathyroid operations are. Please put this picture on your website to show others of the "
old school" parathyroid procedure. I thought I could get a good operation
by my local "best guy". Obviously this is why people go to
This is very typical of parathyroid surgery performed by surgeons
who don't do this operation every single day. We actually see this
every day, and quite
a few that are worse. This was done in Fort Worth, Texas... not exactly small-town
America. Parathyroid surgery performed this way is big and dangerous... and not successful at
least 5-10% of the time. The picture at the top of the page which
shows the neck cut wide open is exactly what this lady's neck looked
like during the first part of her parathyroid surgery, and what yours will
look like if you don't have an
expert. Look, we can't perform everybody's parathyroid
operation, so please, do
your homework. Do not have parathyroid surgery done by some local surgeon
because he was a great guy when he fixed your husband's hernia or
took out your gallbladder! You have a high chance of a poor
outcome. If your surgeon says he/she will "explore" to
find the parathyroid glands, then be prepared for your neck to look
This lady almost surely would have had
a 3/4 inch incision and an operation that took 16 minutes if we did
her parathyroid surgery. She would have gone home about a 1.5 hours
later, and out for dinner with her family. The picture to the right
is typical of our operations performed on the same size woman. Our
photo was taken 7 days after the operation just like the picture
smart! Find an expert parathyroid surgeon.
Suggested Parathyroid Pages to Read Next:
Footnotes for journal articles examining the success
rate of parathyroid operations based upon how often the surgeon does this
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, 2009.