Understanding Parathyroid Disorders
The parathyroid glands are four small glands located behind the thyroid that regulate calcium levels in the body through the production of parathyroid hormone (PTH). The most common disorder affecting these glands is primary hyperparathyroidism, a condition where one or more of the glands becomes overactive, producing excessive PTH and causing elevated calcium levels in the blood.
Symptoms of hyperparathyroidism can include:
- Bone pain and osteoporosis
- Kidney stones
- Abdominal pain and digestive issues
- Fatigue and weakness
- Memory problems and difficulty concentrating
- Depression and mood changes
In some cases, hyperparathyroidism may be asymptomatic and discovered through routine blood tests showing elevated calcium levels. Left untreated, this condition can lead to significant complications, including severe osteoporosis, kidney damage, and cardiovascular problems.
Diagnostic Approach
Accurate diagnosis of parathyroid disorders requires a comprehensive evaluation. At Premier Head and Neck Surgery, our diagnostic approach includes:
- Blood tests to measure calcium, PTH, and vitamin D levels
- 24-hour urine collection to assess calcium excretion
- Bone density testing to evaluate for osteoporosis
- Imaging studies to locate abnormal parathyroid glands:
- Sestamibi scan: A nuclear medicine study that highlights overactive parathyroid tissue
- Ultrasound: To visualize enlarged parathyroid glands
- 4D CT scan: Advanced imaging that provides detailed information about the location of abnormal glands
- MRI: Used in select cases for additional information
This multifaceted approach allows us to confirm the diagnosis and localize the abnormal gland(s) prior to surgery, increasing the likelihood of successful treatment.
Parathyroidectomy Procedure
Parathyroidectomy is the surgical removal of one or more parathyroid glands. At Premier Head and Neck Surgery, we specialize in minimally invasive parathyroid surgery, which offers numerous advantages over traditional approaches.
Minimally Invasive Parathyroidectomy (MIP)
- Small incision (typically 2-3 cm)
- Focused approach targeting only the abnormal gland(s)
- Shorter operative time (usually 30-60 minutes)
- Often performed as outpatient surgery
- Rapid recovery with minimal discomfort
- Excellent cure rates (>95% in appropriate candidates)
Traditional Four-Gland Exploration
- Larger incision with examination of all four parathyroid glands
- Reserved for cases where:
- Preoperative localization is unsuccessful
- Multiple gland disease is suspected
- Previous parathyroid surgery has failed
- Familial hyperparathyroidism is present
Advanced Technology: Medtronic PTH Detection System (Pt-eye)
At Premier Head and Neck Surgery, we utilize the advanced Medtronic PTH detection system, known as Pt-eye, to enhance the precision and success of parathyroid surgery. This cutting-edge technology offers several significant advantages:
Real-time PTH monitoring
Precise gland identification
Reduced operative time
Higher cure rates
Minimizes unnecessary exploration
Reduces the need to examine all four glands when not necessary
The Pt-eye system represents the latest advancement in parathyroid surgery, allowing our surgeons to achieve optimal outcomes with minimal invasiveness. This technology is particularly valuable in cases where imaging studies are inconclusive or when abnormal glands are in unusual locations.
Intraoperative PTH Monitoring
A key component of modern parathyroid surgery is intraoperative PTH monitoring. This technique involves:
- Measuring baseline PTH levels before surgery begins
- Removing the suspected abnormal parathyroid gland(s)
- Measuring PTH levels at intervals after removal (typically 5, 10, and 15 minutes)
- Confirming an appropriate drop in PTH levels (usually >50% from baseline)
This real-time feedback confirms that all hyperactive parathyroid tissue has been removed, providing immediate verification of surgical success and reducing the need for future reoperations.