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Hyperparathyroidism Surgery

Hyperparathyroidism is a condition that is caused by unregulated overproduction of parathyroid hormone. This is generally caused by a benign tumor of a parathyroid gland, which is located in the anterior neck, adjacent to the thyroid gland. The symptoms develop slowly and are initially slight. They can fester for many years and ultimately can become very disabling if left untreated. The diagnosis is generally considered when a patient is discovered as having an elevated serum calcium level. Patients with elevated calcium levels have hypercalcemia. We estimate that 2% of the general population has hypercalcemia and that approximately 1/3 of this group may prove to have hyperparathyroidism. Even people with mild hypercalcemia may have an etiology associated with parathyroid tumors. Once discovered and treated with surgery, patients can experience prompt significant resolution in symptoms.

The symptoms from hyperparathyroidism can range in variety and scope. Many of these symptoms are not specifically a result of the elevated calcium, but are the result of the effects of the elevated parathyroid hormone level. The symptoms of fatigue and irritability are very common in all age groups, whereas joint discomfort and muscle pain are more common in older people with a predisposition for degenerative joint problems. Symptoms of sleep disturbance such as insomnia at night, as well as somnolence during the daytime are common. Additionally weight gain, insulin resistance, and gastroesophageal reflux issues are very common. Many patients newly diagnosed with hyperparathyroidism have been diagnosed with depression or anxiety disorders and may be taking several medications to treat each of these problems. Other commonly ascribed symptoms relating to fatigue and muscle aches and pains, are fibromyalgia and metabolic syndrome. Identification of elevated calcium levels in these patients not only provides a meaningful diagnosis, but also provides a medical treatment that is successful. Correction of hyperparathyroidism with surgery improves these conditions significantly.

The majority of parathyroid surgery is performed by a select few surgeons who have focused their careers in endocrine surgery. The only successful treatment of this disease is surgery, which fortunately is extremely effective in normalizing calcium levels. Complaints of pain and fatigue which are unrelenting prior to surgery seem to fade away in a few weeks. The surgery is delicate and precise, and is therefore associated with a rapid recovery. Incorporating modern surgical techniques, the surgery is performed through tiny incisions, minimizing scarring. The areas deep to the thyroid gland are exposed to identify the normal and abnormal parathyroid tissue. Not all patients have the same disease pattern. Surgery is individualized to the patient's anticipated anatomical abnormality. This is determined by the findings identified by preoperative ultrasound of the neck. Every patient suspected to suffer from this disease should expect to undergo a neck ultrasound, not only to identify an enlarged parathyroid gland, but to also identify potential disease processes in the thyroid gland. This incidence of thyroid cancer is between 5-7% in patients with parathyroid disease. Therefore, findings such as indeterminate thyroid nodules and multiple parathyroid adenomas should be identified before surgery to optimize surgical results.

Most patients have only one enlarged gland called a parathyroid adenoma. The incidence of multi-gland disease rises after the sixth decade and is more common in familial disease and in patients with kidney disease. Identifying normal parathyroid glands during surgery is helpful to ensure that no abnormal tissue is retained. If multi-gland disease is predicted then identification of all glands is an essential component of a successful operation.

The majority of patients undergoing surgery will be released the day of surgery. Patients who have multiple medical problems are at higher potential risk for problems related to anesthesia after the operation. Such patients will be identified in the office and should plan to spend over twelve hours for observation in the hospital after surgery. They will be released the following morning.

After surgery the patients will be expected to consume calcium tablets to prevent a significant drop in blood level calcium levels. Failure to take this calcium may result in severe tingling and cramping of distal muscles in the hands and lower legs. Other symptoms include tingling around fingers and lips. The consumption and integration of calcium is essential in the restoration of bone health.

Dr. Harding is always happy to review all aspects of this surgery with his patients. He feels it is his duty to help them understand how their disease is affecting them, and how surgery should improve their overall health and mental acuity.

Hyperparathyroidism Checklist