Endocrine Cancer Program
The following is a brief contribution from Tracy Wang, MD, MPH, Medical College of Wisconsin Surgeon. Dr. Wang joined the Medical College in 2007 and believes care of each patient should be individualized, while emphasizing a multidisciplinary approach and use of the most recent advances in surgical technique. To make an appointment with Dr. Wang or her colleagues in the Clinical Cancer Center, please call 414-805-0505 or 866-680-0505 .
The Parathyroid GlandThe parathyroid glands are small, pea-sized glands located around the thyroid gland in the neck. Most people have four glands, although some people may have an extra gland and others may be missing a gland.
The parathyroid glands regulate calcium balance in the body by secreting a hormone called parathyroid hormone (PTH). PTH regulates the level of calcium in the blood by releasing calcium from the bone, absorbing calcium from the intestine, and excreting calcium in the urine. When the calcium level in the blood increases, the amount of parathyroid hormone released by the parathyroid gland decreases until the calcium level returns to normal.
Primary HyperparathyroidismPrimary hyperparathyroidism is characterized by hypercalcemia (abnormally elevated calcium levels in the blood) and elevated PTH levels. It is the result of an abnormality of the parathyroid gland that disrupts the normal balance of calcium by producing too much PTH, even with high calcium levels.
Primary hyperparathyroidism occurs in approximately 100,000 people each year. Most cases have no known cause. A small percentage of cases occur in people with a family history of parathyroid disease. The most common cause of primary hyperparathyroidism is a growth of the parathyroid gland; it is almost always benign. For 85-90 percent of patients, only one of the four parathyroid glands is enlarged and overactive (a parathyroid adenoma). In the remaining patients, more than one parathyroid gland is involved in the overproduction of PTH (multiglandular hyperplasia).
Over time, patients with primary hyperparathyroidism are at risk for developing kidney stones, pancreatitis, gastroesophageal reflux disease, peptic ulcer disease, osteopenia, osteoporosis, and bone fractures. In addition, it may be related to an overall feeling of fatigue, bony aches and pains, difficulty with memory and concentration and mood swings. Patients with hyperparathyroidism may have severe symptoms, subtle symptoms, or none at all.
DiagnosisPrimary hyperparathyroidism is diagnosed by a combination of tests, including elevated calcium levels in the blood and elevated PTH levels. Other tests may be done to confirm the diagnosis or to assess complications of hyperparathyroidism. These include vitamin D levels, a 24-hour urine collection, and a measurement of bone density.
TreatmentSurgery is the only cure for hyperparathyroidism; there are currently no medications to treat primary hyperparathyroidism. When treated by experienced endocrine surgeons, the cure rate for primary hyperparathyroidism after surgery is greater than 95 percent.
Indications for SurgerySurgery is recommended for patients with kidney stones, bone fractures, or peptic ulcer disease. Surgery may also help decrease bone loss for patients with osteopenia or osteoporosis. Some patients also notice an improvement in their blood pressure, heart disease, energy levels and mood after surgery. Research has shown that patients report having improved quality of life after surgery. After successful surgery, calcium levels should return to normal and remain normal in 95 percent of patients.
Minimally invasive parathyroidectomyAt the Froedtert & The Medical College of Wisconsin, our team of endocrine surgeons performs a minimally invasive parathyroidectomy whenever possible. This technique uses a protocol of preoperative localization studies and intraoperative parathyroid hormone monitoring. In select patients, this operation can also be done with sedation and local anesthesia. Many patients are discharged from the hospital on the same day of surgery.
Preoperative LocalizationThe goal of preoperative localization is to identify which of the four parathyroid glands is enlarged. At Froedtert & The Medical College of Wisconsin, this is done using a protocol of Sestamibi scanning, ultrasound and computed tomography (CT). This allows for a focused operation that minimizes the risk of complications from surgery.
Intraoperative Parathyroid Hormone MonitoringThe half-life of parathyroid hormone is only three to four minutes. During surgery, parathyroid hormone levels can be measured while the patient is still in the operating room. As a result, our surgeons are able to confirm that all overactive parathyroid tissue has been removed.
Recurrent HyperparathyroidismA small percentage of patients will develop recurrent hyperparathyroidism after surgery. The most common cause of recurrent disease is incomplete removal of all parathyroid disease at the initial surgery. In the hands of an experienced surgeon familiar with reoperative surgery, the success rate is greater than 90 percent with minimal complications.
Author: Tracy Wang, MD, MPH
|Medical Reviewer: ||Tracy Wang, MD, MPH|
Last Review Date: Feb. 4, 2009