Minimally Invasive Parathyroid Surgery
We are the first in this community to offer this true minimally invasive procedure, designed to remove parathyroid tumors. During a Minimally Invasive Parathyorid (MIP) Surgery we use an incision often less than one inch long.
We utilize radioisotope probes in surgery to isolate and remove the correct lesion. This allows us to remove the exact parathyroid tumor that is indicated. It also helps us confirm that the surgery was sucessful.
We also use NIMM nerve monitoring during surgery to protect the important nerves that control the vocal cords. With this device we can identify the important nerves that control the vocal cords and more exactly protect them during the surgery.
These procedures are often done as an outpatient, where you can go home the same day as the surgery. There is very little discomfort and rapid recoveries are common. One common problem following parathyroid surgery is an actual drop in calcium levels. This can cause some disturbing symptoms. Information about treating this problem can be found at this link. Treatment following Parathyroid Surgery
What are the parathyroid glands?
The parathyroid glands are four pea-sized glands located behind the thyroid gland in the neck.
Though their names are similar, the thyroid and parathyroid glands are entirely different glands, each producing distinct hormones with specific functions. The parathyroid glands secrete PTH, a substance that helps maintain the correct balance of calcium and phosphorus in the body. PTH regulates the level of calcium in the blood, release of calcium from bone, absorption of calcium in the intestine, and excretion of calcium in the urine.
When the level of calcium in the blood falls too low, the parathyroid glands secrete just enough PTH to restore the blood calcium level.
What is hyperparathyroidism?
If the parathyroid glands secrete too much hormone, as happens in primary hyperparathyroidism, the balance is disrupted: Blood calcium rises. This condition of excessive calcium in the blood, called hypercalcemia, is what usually signals your doctor that something may be wrong with the parathyroid glands. In 85 percent of people with primary hyperparathyroidism, a benign noncancerous tumor called an adenoma has formed on one of the parathyroid glands, causing it to become overactive. In most other cases, the excess hormone comes from two or more enlarged parathyroid glands, a condition called hyperplasia. Very rarely, hyperparathyroidism is caused by cancer of a parathyroid gland.
The excess PTH triggers the release of too much calcium into the bloodstream. The bones may lose calcium, and too much calcium may be absorbed from food. The levels of calcium may increase in the urine, causing kidney stones. PTH also lowers blood phosphorus levels by increasing excretion of phosphorus in the urine.
Why are calcium and phosphorus so important?
Calcium is essential for good health. It plays an important role in bone and tooth development and in maintaining bone strength. Calcium is also important in nerve transmission and muscle contraction.
Phosphorus is found in all bodily tissue. It is a main part of every cell with many roles in each. Combined with calcium, phosphorus gives strength and rigidity to your bones and teeth.
What causes hyperparathyroidism?
In most cases doctors don't know the cause. The vast majority of cases occur in people with no family history of the disorder. Only about 5 percent of cases can be linked to an inherited problem. Familial multiple endocrine neoplasia type 1 is a rare, inherited syndrome that affects the parathyroids as well as the pancreas and the pituitary gland. Another rare genetic disorder, familial hypocalciuric hypercalcemia, is sometimes confused with typical hyperparathyroidism. Each accounts for about 2 percent of primary hyperparathyroidism cases.
How common is hyperparathyroidism?
In the United States, about 100,000 people develop the disorder each year. Women outnumber men two to one, and risk increases with age. In women 60 years and older, two out of 1,000 will develop hyperparathyroidism each year.
What are the symptoms of hyperparathyroidism?
A person with hyperparathyroidism may have severe symptoms, subtle ones, or none at all. Increasingly, routine blood tests that screen for a wide range of conditions, including high calcium levels, are alerting doctors to people who have mild forms of the disorder even though they are symptom-free.
When symptoms do appear, they are often mild and nonspecific, such as a feeling of weakness and fatigue, depression, or aches and pains. With more severe disease, a person may have a loss of appetite, nausea, vomiting, constipation, confusion or impaired thinking and memory, and increased thirst and urination. Patients may have thinning of the bones without symptoms, but with risk of fractures. Increased calcium and phosphorus excretion in the urine may cause kidney stones.
How is hyperparathyroidism diagnosed?
Hyperparathyroidism is diagnosed when tests show that blood levels of calcium and parathyroid hormone are too high. Other diseases can cause high blood calcium levels, but only in hyperparathyroidism is the elevated calcium the result of too much parathyroid hormone. A blood test that accurately measures the amount of parathyroid hormone has simplified the diagnosis of hyperparathyroidism. A parathyroid scan is a very helpful test to localize the location of the tumor.
Once the diagnosis is established, other tests may be done to assess complications. Because high PTH levels can cause bones to weaken from calcium loss, a measurement of bone density can help assess bone loss and the risk of fractures. Abdominal images may reveal the presence of kidney stones and a 24-hour urine collection may provide information on kidney damage, the risk of stone formation, and the risk of familial hypocalciuric hypercalcemia.
How is hyperparathyroidism treated?
Surgery to remove the enlarged gland (or glands) cures hyperparathyroidism in 95 percent of patients.