Pain in the Neck?

Montefiore Cuts Parathyroid Surgery Down to Size

Illustration © The Staywell Company. All rights reserved.

You’re sluggish, you’ve lost your appetite, and you seem to be thirsty quite often. If you have these sometimes-subtle symptoms, talk with your doctor. They could be signs of a condition called hyperparathyroidism. It occurs when one of your parathyroid glands becomes enlarged.

The parathyroid glands are four pea-sized glands located in the neck behind the thyroid. They produce a hormone, called the parathyroid hormone (PTH), which helps maintain a normal blood-calcium level in the body. Some people develop benign tumors that cause one of their glands to enlarge. The affected gland may secrete too much PTH, which can raise the calcium level in the body to an unhealthy level.

During traditional parathyroid surgery, doctors make large 6 to 10 centimeter (cm) incisions in the neck so they visually can inspect all the parathyroid glands and identify and remove the enlarged glands. Since most patients have only one enlarged gland, this procedure is much more invasive than many patients need and can leave a lengthy scar. Fortunately, this type of surgery, which requires general anesthesia and an overnight hospital stay, is no longer the only option for patients with hyperparathyroidism.

“We can now cure patients with hyperparathyroidism during a scan-guided minimally-invasive procedure that involves locating the enlarged gland before we perform surgery,” says Randall Owen, MD, MS, chief of Head and Neck Surgery, Department of General Surgery, Montefiore Medical Center, and assistant professor of Surgery, Albert Einstein College of Medicine. “This innovative one-hour procedure has the same success rate as traditional surgery but is much easier on patients.”

Before parathyroid procedures, surgeons take a specialized scan that allows them to identify the enlarged gland. While patients are under local anesthesia and sedation, surgeons make a small 3.5 cm incision – about half the size of the traditional incision – in the neck and remove the diseased gland. They use special technology to obtain a rapid PTH level to confirm that the patient’s hormone level has returned to the normal range before completing the procedure. About one in 10 patients has more than one enlarged gland and may need additional surgery.

“There’s no need for a hospital stay so patients can be home in time for dinner on the day they have surgery,” Dr. Owen says. “Patients have less pain and a much smaller scar that they don’t need to hide.”

Montefiore is one of only a few hospitals in the New York metropolitan area with head and neck surgeons who specialize in and offer minimally-invasive parathyroid surgery.

Bigger Is Not Always Better: Symptoms of Enlarged Parathyroid Glands
Some patients with enlarged parathyroid glands – or hyperparathyroidism – have many symptoms, while other patients have no symptoms, or they attribute their symptoms to other conditions. Patients who have a diagnosis of osteoporosis or kidney stones should alert their doctors to the possibility of hyperparathyroidism. Over time, the elevated calcium levels associated with hyperparathyroidism can damage the kidneys and bones. Talk with your physician if you have these signs:
Loss of appetite Thirst Frequent urination Lethargy or fatigue Muscle weakness Joint pain Constipation	Nausea and vomiting Abdominal pain Memory loss Depression Gastric ulcers Pancreatitis Bone pain

To receive a brochure or to make an appointment, please call 1-800-MD-MONTE. To learn more about head and neck surgical options at Montefiore, visit www.montefiore.org/surgery.