A parathyroid gland is any one of the four small, round glands at the back of the thyroid, which are responsible for the regulation of calcium in the bloodstream. They control the calcium level by affecting a variety of organs including the kidney, intestines, and bones. Despite their close proximity, the thyroid and parathyroid are very different glands with very different purposes and the problems that affect them must be understood and dealt with accordingly.

However, whether we are performing thyroid surgery or looking into a possible parathyroid problem, we use advanced techniques to perform diagnostic and surgical; procedures with minimal damage to surrounding tissues. This minimally invasive approach significantly reduces the risk of surgical complication as well as shortening healing time.

Hyperparathyroidism

Hyperparathyroidism is a condition in which the parathyroid creates more of the parathyroid hormone than it needs to, causing an imbalance in the amount of calcium in the body. This can lead to problems with the bones, muscles, nervous system, and kidneys. The most common form of this condition is primary hyperparathyroidism, which is caused by either an adenoma (benign growth) or enlargement of all of the parathyroid glands. Parathyroid adenomas are the most common cause of primary hyperparathyroidism and can occur in more than 90% of cases. 5-10% of case are caused by disease in more than one gland.

Less common is secondary hyperparathyroidism, in which an underlying medical condition (usually kidney failure) triggers the malfunction of the parathyroid. Treatment for hyperparathyroidism depends on the type and degree of the condition. Primary hyperparathyroidism is most effectively treated with surgery to remove the affected glands, while secondary hyperparathyroidism is best addressed by treating the underlying medical problem.

back to top

Signs and Symptoms

Calcium is used by every cell and organ in the body to function; as such calcium imbalance can have a wide range of signs and symptoms.

The severity of symptoms does not go hand in hand with the level of rise in calcium. Some patients with slight elevation in calcium will have severe osteoporosis. Because the symptoms are so non-specific and the patients can have any combination of symptoms, they are not appropriately diagnosed as having a parathyroid disorder, and the patients go untreated. Interestingly enough even the patients who are without symptoms find that they feel much better after surgery.

In several medical studies it has been shown that 95% of patients state they feel better after surgery. As early as 72 hours after surgery, most patients feel an improvement in many of the symptoms. All patients with hyperparathyroidism will develop osteoporosis. Taking medications such as Fosamax or Actonel will not help bones that are less dense due to parathyroid disease. Long-standing elevation in calcium places a heavy burden on the body and has been proven to lead to a decreased life expectancy. Parathyroid disease only gets worse with time in all everyone. It will continually change, and will not get better on its own.

back to top

Diagnosis

Physicians recognizing a combination of signs and symptoms make the diagnosis. However, in most cases routine laboratory tests show a persistent increase in blood calcium levels. Checking the level of parathyroid hormone PTH follows this. A combination of an elevated calcium and PTH level confirms hyperparathyroidism. However, there are times when the calcium stays elevated without a significant elevation in PTH. A fluctuation in the blood calcium level from high to normal range and high again is a frequent occurrence in patients with parathyroid disease.

Fig. 12 - Sestamibi Scan

Identifying the location of the abnormal parathyroid gland (parathyroid adenoma) is very important in planning the surgical treatment. A sestamibi scan is the preferred method to find the location of the abnormal parathyroid gland. This is a very technically challenging test, and in order to get accurate results it must be done by imaging centers with expertise. To precisely locate the gland with respect to the thyroid, trachea and other structures a CT scan of the neck can be performed.

Fig. 13 - Scan

Treatment

There are no drugs that can effectively treat parathyroid disease. Surgery is the only successful treatment for primary hyperparathyroidism. The surgery is called parathyroidectomy and it means to remove one or all parathyroid glands. The traditional surgical approach involved a large incision and exploration of both sides of the neck. Dr. Larian is one of the few surgeons in the country performing minimally invasive parathyroidectomy via a small incision as well as intra-operative PTH hormonal assay to ensure a more effective and less invasive procedure.

Primary hyperparathyroidism that is significant enough to need treatment is traditionally addressed by removing the affected parathyroid gland or glands. Although this procedure was once extremely invasive, newer techniques allow us to access the parathyroid through very small incisions (less than an inch), resulting in minimal trauma to surrounding tissues and a much shorter recovery period. This is especially true in cases of parathyroid adenoma, where the adenoma has been located through various studies (Sestamibi, CT Scan). By using rapid intra-operative PTH testing we confirm the success of surgery and an appropriate drop in the PTH level in the operating room. Due to the ease of this procedure, in certain cases it can be done under loco-regional anesthesia.

back to top

Parathyroid pamphlet	Parathyroid post op

Contact Dr. Babak Larian

If you would like to speak with our ear, nose, and throat surgeon in Beverly Hills, serving all of Southern California, simply contact our office today to schedule an appointment.

back to top