Parathyroid disease and parathyroid treatment is discussed by parathyroid doctors and parathyroid surgeons for parathyroid patients.

 

Section 3.

Treatment of Parathyroid Disease

Most parathyroid patients can have minimally invasive parathyroid surgery for their parathyroid disease.

Who is Eligible for Mini-Parathyroid Surgery and MIRP Surgery?
This Flow Chart Tells All. Updated January 13, 2004

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Parathyroid surgery and mini-parathyroid surgery for ALMOST ALL patients.

Tips and Tricks regarding parathyroid operations.Who can have mini-parathyroid surgery and mini parathyroid operation.It is clear that ALMOST EVERY patient with primary hyperparathyroidism is a candidate for minimally invasive parathyroid surgery using intraoperative nuclear mapping (MIRP). This is also called "radioguided parathyroid surgery". About 99% of all parathyroid patients can have this mini operation.  Even if a person has a NEGATIVE sestamibi scan, they can still have a mini parathyroid operation that uses these new techniques!  Thus, virtually ALL patients can have a smaller, simpler, faster, and more successful parathyroid operation using radioguided techniques. This is very important for you to know!

Who can have mini-parathyroid surgery and mini parathyroid operation.While virtually every patient can have a smaller, radioguided parathyroid operation, those with a single radioactive parathyroid gland on high-quality sestamibi scan can have the smallest version of this mini-parathyroid operation (typically lasting around 14 to 20 minutes). 

Remember, about 5 percent of all patients with primary hyperparathyroidism will have four-gland hyperplasia--which means that all four of the parathyroid glands have become diseased and are over-producing parathyroid hormone. About 1 in 100 or so will have the rare multiple parathyroid adenoma which is 2 bad glands and 2 normal glands. But regardless of what problem exists with the parathyroids (1 bad, 2 bad, 3 bad or 4 bad) ALMOST ALL patients can have a mini parathyroid operation IF THE SURGEON KNOWS HOW TO DO IT.

Of the 95 percent of patients that have a single bad parathyroid gland (a parathyroid adenoma), most will have a sestamibi scan that shows the bad gland (very dependant on how good the scan is an how often the radiology tech does the scan--read more about sestamibi here). Some people with just one bad parathyroid will not have a sestamibi scan which shows which parathyroid gland is the bad parathyroid... HOWEVER, they can still have a MIRP mini operation--if the surgeon is experienced in doing parathyroid operations and is comfortable doing them. Almost ALL patients should be able to go home within one or two hours of parathyroid surgery in 2004. If your surgeon is not doing this, then find an expert! If your surgeon wants you to spend 2 or 3 days in the hospital after parathyroid surgery--RUN---and find another surgeon! This doctor is still living in the 1970's and is not as comfortable with this disease as he/she should be.

About 90 percent of all patients with parathyroid disease who are candidates for the SMALLEST minimal parathyroid operation--the 14 - 20 minute MIRP. As centers have gained more experience over the past few years, this rate has climbed gradually. Editor's Note: The author's institution (Norman Parathyroid Clinic) is able to perform the minimal operation on about 99 percent of all parathyroid patients. This rate is due to their extensive experience in parathyroid surgery and the volume of parathyroid patients they see. parathyroid surgery at Norman parathyroid surgery clinic. parathyroid surgery, parathyroid operation parathyroid,

Pre-op flow chart to determine the type of operation needed in patients with parathyroid disease who need parathyroid surgery.

Who can have mini-parathyroid surgery and mini parathyroid operation.The minimally invasive approach to parathyroid surgery is performed using local anesthesia (or LMA anesthesia which is a great advance, and most patients are sent home within 1 - 2 hours following the operation. The same-day surgery rate should average better than 95 percent of ALL parathyroid patients, with very few (almost none!) sent home the following morning.

Who can have mini-parathyroid surgery and mini parathyroid operation.Depending on the experience of the surgeon, sometimes those undergoing a standard bilateral parathyroid operation are sometimes kept overnight (23 hour stay). It is becoming quite uncommon for patients to stay longer than 23 hours following routine standard parathyroid surgery. But, underlying diseases and other conditions such as age greater than ~85 will increase the likelihood of staying longer. REMEMBER...the emphasis is on quality of care and cure of the parathyroid disease, NOT on how fast the patient is sent home! As stated above, if your surgeon keeps all patients in the hospital for 2 days (or more) to measure the calcium... then find another surgeon. Those days are gone and your surgeon is not doing enough parathyroid surgery to be comfortable with all of the newer techniques and the better ways to manage this disease. (NOTE, The Norman Parathyroid Clinic keeps less than 2% of patients overnight following a parathyroid operation... ALL TYPES of parathyroid operations). Parathyroid surgery at the Norman Parathyroid surgery clinic.

Probe used to find over active parathyroid gland for radioguided parathyroid surgeryWho can have mini-parathyroid surgery and mini parathyroid operation.What if your hospital doesn't have a nuclear probe like the one shown in this picture? These parathyroid probes have only become widely available during the late 1990's. This is the probe that the surgeon uses in the operating room to find the radioactive (over-active) parathyroid gland (Read more about how this is done by clicking here). Sometimes, a few surgeons will perform mini-parathyroid surgery without the probe, but this should only be done by an experienced parathyroid surgeon--one that does MORE THAN 100 parathyroid operations per year!!! The days of giving all parathyroid patients a big operation are gone! If your surgeon intends to do a standard parathyroid operation without even checking to see if you are a candidate for mini parathyroid surgery, go somewhere else! To read more about the different cure rates for surgeons with different levels of experience, go to this page of Parathyroid.com. This is very interesting information!

Bottom line: Surgeons who perform only a few parathyroid operations per year have a cure rate of approximately 85%. Surgeons who do more than 200 parathyroid operations per year have a cure rate of over 98%. Complication rates are more than doubled as well for surgeons who operate on parathyroid infrequently!  Pick your surgeon carefully!

 

Home ] Up ] Parathyroid Intro ] Normal Function ] Hyperparathyroidism ] Symptoms ] Diagnosis ] Osteoporosis ] Treatment/Surgery ] Mini-Surgery ] Parathyroid Pictures ] Finding the Tumor ] Who Gets It? ] Do I Have Just One? ] What Causes It? ] Sestamibi Scan ] Surgery Cure Rates ] What Experts Say ] Frequent Questions ] High Blood Calcium ] Low Vitamin D ] Diagnosis-ADVANCED ] 10 Parathyroid Rules ] Sensipar ] Publications ] Parathyroid Cancer ] Re-Operate ] Hyp0parathyroid ] What Patients Say ] Table of Contents ] Dr. Norman ] About Us ]

Parathyroid.com is an educational service of the Norman Parathyroid Clinic, the world's only parathyroid-exclusive clinic, 
consulting on over 3500 parathyroid patients and performing approximately 1800 mini-parathyroid operations annually.
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