- Pituitary gland
- Thyroid gland
Causes of Familial Hyperparathyroidism
- Kidney stones
- Fragile bones that easily fracture (osteoporosis)
- Excessive urination
- Abdominal pain
- Tiring easily or weakness
- Depression or forgetfulness
- Bone and joint pain
- Frequent complaints of illness with no apparent cause
- Nausea, vomiting, or loss of appetite
- Abdominal pain
- Burning, aching, or hunger discomfort in the upper abdomen or lower chest that is relieved by antacids, milk, or food
- Black, tarry stools
- Nausea and vomiting
- Bloated feeling after meals
- Vision problems
- Loss of coordination
- Mental changes or confusion
- Coma if hypoglycemia is untreated
- Loss of appetite
- Muscle pain
- Sensitivity to the cold
- Unintentional weight loss
- Low blood pressure
- Loss of pubic hair
- In women, cessation of menses, infertility, or failure to lactate
- In men, decreased sexual interest, loss of body or facial hair
- Abdominal pain
- Poor appetite
- Frequent thirst
- Frequent urination
- Muscle twitches
- Muscle weakness
- Memory loss
- Bone pain
- Bowing of the shoulders
- Bone fractures
- Loss of height
- Curvature of the spine
- Parathyroid Localization: For certain parathyroid conditions, having radiographic images, which document the location of the enlarged and hyperfunctioning parathyroid glands, are necessary. These may include parathyroid ultrasound, SESTAMIBI scan with SPECT, special CT scans, etc. Your surgeon will determine the best parathyroid localization imaging that you should undergo. Appropriate localization is necessary for Minimally Invasive Parathyroidectomy (MIP), and reoperative surgery for all parathyroid conditions.
- Traditional (Bilateral) Parathyroidectomy: This approach involves exploring both sides (bilateral) of the neck in order to identify and remove the affected parathyroid glands. This method is usually done under general anesthesia using open surgery.
Bilateral surgery is necessary when it appears that both sides of the neck contain affected parathyroid glands, or if nodules need to be removed from the thyroid gland as well.
- Focused or Directed (Unilateral): This approach involves exploration of only one side (unilateral) of the neck using a small incision and specialized minimally invasive instruments.
Preoperative imaging is necessary to determine which side has the diseased parathyroid glands. If one side cannot be determined through imaging, unilateral surgery is not possible.
Surgeons must make sure that the condition is resolved before the end of the surgery. To do this, an intraoperative PTH assay is used to confirm that PTH (parathyroid hormone) blood levels decrease within a certain range after the affected parathyroid glands are removed. If not, it may indicate that other parathyroid glands are affected and bilateral exploration may be necessary.
Both traditional and focused parathyroid procedures may require preoperative imaging depending on the approached being used and the condition being treated.
Some imaging tests include a parathyroid scan, a neck ultrasound, a CT scan, and an MRI.
Intraoperative adjuncts may also be necessary before the surgery is completed. These may include PTH (parathyroid hormone) monitoring, PTH assay to be certain the hormone levels are corrected after the parathyroid glands have been removed, a frozen section to confirm parathyroid hyperplasia, and cryopreservation of parathyroid tissue in order to freeze and store some tissue in case it is needed for the patient at a later date.
- Minimally Invasive Parathyroid Surgery: This surgery is performed under local analgesia with sedation, with a small incision to remove the enlarged parathyroid gland(s). While removing the gland(s), the surgeon talks with the patient to ensure that the recurrent laryngeal nerve is not affected by the surgery. After removal of the affected gland(s), and while the patient is still under sedation, the surgeon performs a blood test to check the patient's parathyroid hormone level in the operating room. This blood test will allow the surgeon to confirm that all enlarged parathyroid glands have been removed before the patient leaves the operating room. Patients will recover in the hospital for 24 to 72 hours so that blood calcium levels can continue to be monitored.
- Reoperative Parathyroid Surgery: After a parathyroidectomy, the calcium levels and parathyroid hormone levels (PTH) are checked using blood tests to be certain that they return to normal. Tests are repeated again in about six months. If levels remain elevated, reoperative parathyroid surgery may be necessary.
The number of patients who need reoperative parathyroid surgery is only between 2 and 5 percent. Reoperative parathyroid surgery is extremely specialized because it involves more risk than the initial parathyroid procedure, making the surgery more complex. Our expert surgeons are highly experienced in performing reoperative parathyroid surgery and have a high success rate.
- Persistent primary hyperparathyroidism occurs when the calcium and PTH levels do not return to normal levels following the removal of affected parathyroid glands. This form of hyperparathyroidism usually occurs if not all diseased parathyroid tissue is removed. Tissue may be missed for several reasons, including a surgeon’s inexperience, ectopic glands in a difficult-to-find location, or multiple diseased glands.
- Recurrent primary hyperparathyroidism occurs when calcium and PTH levels are normal following surgery but then once again become elevated high six months after the initial surgery. Recurrent hyperparathyroidism usually occurs when one or more of the remaining glands become hyperactive.