What is primary hyperparathyroidism?
Primary hyperparathyroidism is a common endocrine disorder that occurs most often as a result of a sporadically occurring single parathyroid adenoma (>85%) and less often due to parathyroid hyperplasia involving all four glands. The only cure is surgical removal of the offending gland(s).
How is primary hyperparathyroidism treated?
Diagnostic techniques and surgical management protocols for parathyroid disease have under-gone a paradigm shift over the last 10-20 years, with a focus on less invasive surgery and greater dependence on technology for preoperative localization, facilitation of less invasive sur-gery, and intraoperative confirmation of removal of correct tissue to resolve the disease process. The transition from traditional, bilateral, 4 gland exploration (four gland exploration or FGE) to directed and minimal dissection single gland removal when supported by high-quality preoperative imaging (directed exploration or DE), has been shown to produce comparable suc-cess (cure) rates and complication rates.
A common pursuit in today’s parathyroid surgical care is the use of rapid intra-operative para-thyroid assay. Of patients with preoperative localization and directed excision, the preoperative studies most predictive of cure are Sestamibi parathyroid scans. Intraoperative parathyroid hormone rapid assay is not associated with a higher cure rate interestingly and does add signifi-cant time to the procedure. Most patients with persistent high parathyroid hormone levels after parathyroid surgery are found to have had associated vitamin D deficiency.
What should you do to work-up a patient you believe has hyperparathyroidism?
Analysis of techniques that predict a surgical cure allowe the development of a best practices algorithm that includes the following: 1. Obtain 2 preoperative localization studies, including an ultrasound; 2. Obtain preoperative vitamin D levels and supplement as indicated; and 3. Reserve intraoperative parathyroid hormone assay only for those patients who do NOT have 2 cor-roborating localization studies.
The management of parathyroid disease can be complex. If you have any questions regarding this or other area of ear, nose, throat, head and neck cancer, sleep surgery, thyroid and parathy-roid, please do not hesitate to call. ENT is trained in 7 core areas over a 5 year residency after medical school: allergy, facial plastic and reconstructive surgery, head and neck, laryngology, otology, pediatric otolaryngology, and rhinology. We are the only surgical specialty dedicated solely to this area.
Philip Harris, M.D. FACS
MidMichigan Physicians Group
Midland / Gladwin / Bay City
Phone (989) 839-6201