Treatment options for parathyroid disorders

December 01, 2012
John Butler, MD, Surgeon

Problems involving the parathyroid glands can be treated at UC Irvine Medical Center with minimally invasive surgery and intraoperative hormone monitoring—an innovative combination that offers many benefits.

The parathyroids are four tiny glands each about the size of a grain of rice, located below the neck, underneath the thyroid gland.  They are part of the endocrine system, which controls major processes including growth, metabolism and reproduction.  By producing parathyroid hormone (PTH), these glands play an important role in controlling the level of calcium in the blood. This level must stay within a very narrow range, because calcium levels affect bone health as well as proper nerve and muscle function.

Disorders of the parathyroid glands cause too much PTH to be produced. “Hyperparathyroidism” arises from uncontrolled cellular growth. This can result in either a benign (noncancerous) tumor in one gland, a general enlargement of glands, or multiple tumors in one or more glands.  Most growths are benign, with parathyroid cancers accounting for only 1 percent of cases. Yet even benign growths can cause serious problems because they disrupt normal calcium metabolism. A malfunctioning parathyroid can lead to painful kidney stones, as well as pain in the bones and stomach. In fact, “stones, bones and groans” is the phrase medical students use to identify the symptoms commonly caused by parathyroid problems.

Surgery is generally needed to remove enlarged parathyroid glands. Traditional surgery requires a large incision, and involves a certain amount of trauma while the parathyroids are located and tested.  Today, minimally invasive parathyroid surgery offers patients a less traumatic operation with excellent results.  At UC Irvine Medical Center, this surgery is combined with intraoperative PTH monitoring, which indicates exactly when all the problematic tissue has been removed.

To begin, the patient receives an injection of a radioactive isotope called sestamibi.  Next, a PET scan is performed to reveal which of the parathyroid glands are involved, and to identify their locations.  During surgery, the first affected gland is removed, and the patient’s blood is quickly tested to see if the PTH level is reduced. If not, additional glands may be taken out.

In 85 percent of cases, only a single gland is affected, meaning that only a small incision is required.  Minimally invasive surgery permits more rapid recovery, reduces the risk of complications and leaves a smaller scar.

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