Advances Simplify Surgery for Hyperparathyroidism

 

By Cory Foster, MD

 

 

 

Located in the neck, behind the thyroid gland, sit four small glands called the parathyroids. These two pairs of glands, which are part of the body’s endocrine system, regulate the amount of calcium in the body’s bloodstream. This is an important function because calcium is a significant nutrient and is utilized throughout the body.

 

When the parathyroid glands are not functioning normally, a condition known as hyperparathyroidism can develop. Left untreated, this condition may lead to kidney problems, osteoporosis, and a host of other related symptoms.  Hyperparathyroidism is a problem that is probably under-diagnosed, but once identified, it is very treatable. Moreover, recent advances in diagnostic imaging and minimally invasive surgery enable people to recover more rapidly and resume normal activities.

 

What is hyperparathyroidism?

 

When the level of calcium in the bloodstream falls too low, the parathyroid glands produce parathyroid hormone  (PTH) and release it directly into the bloodstream. This, in turn, signals the bones in the body to release calcium into the blood. Conversely, when our calcium blood levels are too high, the parathyroid glands stop producing PTH. Hyperparathyroidism is caused by excessive levels of PTH in the body and it is suspected when lab tests show both an elevated blood calcium level and an elevated level of PTH in the blood.

 

Why are high levels of blood calcium undesirable?

 

Although many people with hyperparathyroidism suffer no symptoms, if left untreated, high calcium levels can lead to kidney stones (calcium is one element of kidney stones), osteoporosis (PTH takes calcium from the bones to put into the blood), fatigue, weakness, depression, constipation, and other complaints. Many of these symptoms look like other problems, but can easily be remedied with surgery.

 

How is hyperparathyroidism treated?

 

The only curative treatment for hyperparathyroidism is to remove the affected glands surgically. There are medications that can lower blood calcium but these drugs don’t ultimately cure problems with the parathyroid glands. This is because hyperparathyroidism is typically caused by one of two conditions: a gland adenoma, which is a benign growth on one or more of the parathyroid glands; or, parathyroid hyperplasia, which is a subtle overgrowth of all four glands.  Only rarely do we see cases of parathyroid cancer.

 

What happens during parathyroid surgery?

 

To reduce the inherent risks associated with neck surgery, surgeons are adopting a new minimally invasive approach that uses advanced imaging technology. We first evaluate the patient with high-resolution ultrasound and a sestamibi scan, which is an imaging study that uses radioactive material to highlight parathyroid glands that are abnormal. These tests allow the surgeon to pinpoint the enlarged gland, which typically limits the surgery to one side of the neck only. Using this approach, we can reduce the risk of bleeding, nerve damage, and trauma to the thyroid and other parathyroids.

 

In addition to these advanced imaging techniques, at Cayuga Medical Center we are also using a test called rapid intraoperative PTH assay. This test allows us to remove the suspicious gland and confirm within 20 minutes whether the patient’s blood calcium level has dropped. If the calcium level has dropped, we know we have removed the affected gland; if the calcium level does not drop, we look for another gland that is also functioning improperly and contributing to the problem. With the results of the rapid PTH assay, the surgeon can close the incision more quickly and eliminate the need for a second surgery. Minimally invasive parathyroid surgery is performed as same-day surgery.

 

Dr. Foster, who is board certified in general surgery, has a special interest in parathyroid surgery. She is a member of the medical staff at Cayuga Medical Center and is in practice with Surgical Associates of Ithaca, where she can be reached at (607) 273-3161. Dr. Foster graduated from the Medical College of Pennsylvania, where she also completed her internship and surgical residency. She went on for a fellowship in surgical nutrition at Johns Hopkins University School of Medicine in Baltimore.