Parathyroid Disorders

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About Parathyroid Disorders

High levels of calcium in your blood may signal the presence of hyperparathyroidism, which is associated with overactive or enlarged parathyroid glands. In very rare cases, extremely high calcium levels may also signal parathyroid cancer.

If your hyperparathyroidism requires treatment or parathyroid cancer is suspected, surgery is usually recommended.

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Treatments

Parathyroid Surgery

Surgery is the first-line treatment for primary hyperparathyroidism and has cure rates in excess of 95%. We are one of the few centers in the country to use minimally invasive parathyroidectomy when appropriate to remove overactive parathyroid glands in an outpatient setting under local anesthesia. As a result, you experience less pain and recover faster than traditional surgery.

In some cases, more complex surgery may be needed to surgically remove multiple overactive glands. For the very rare instance of parathyroid cancer, surgery may also include removal of lymph nodes, thyroid tissue, muscles and nerves from the neck or the affected area, depending on the extent of disease.

Targeted Parathyroid Cancer Therapy

Parathyroid cancer is found in less than 1% of patients with hyperparathyroidism. Cancer may be suspected if the blood calcium level is very high. If cancer is present, surgery is the best treatment. However, if the disease has spread beyond the neck area, chemotherapy, in the form of a pill or injection, and/or radiation, which delivers high energy X-rays, may be recommended after surgery to slow, shrink or halt the growth of cancerous cells.

Autotransplantation

If you have recurrent secondary hyperparathyroidism induced by kidney failure, or multiple endocrine neoplasia type 1, it is sometime necessary to remove all parathyroid glands from the neck area, as they are all affected. However, because parathyroid function is extremely important in our bodies, it is important to preserve parathyroid function by transplanting a portion of the removed parathyroid gland into your arm. Up to 20 percent of these transplants are known to be unsuccessful. In order to provide a safety net for these patients who may have failed first-time parathyroid autotransplants, we freeze sections of the previously removed parathyroid glands (cryopreserve them) in the event that a second transplant is needed.

Medication

Medications may be used in urgent settings for a short period of time if your blood calcium level is dangerously high and needs to be controlled prior to surgery. If you cannot undergo surgery because of other illnesses, medications, such as cinacalcet, may be prescribed to control calcium levels and related symptoms. Medications are more commonly used as treatment for secondary hyperparathyroidism from kidney failure.

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Tests

Blood Tests

The diagnosis of hyperparathyroidism is made by testing blood for calcium, parathyroid hormone, creatinine, and vitamin D levels. Screening blood tests for calcium levels is routine, and can detect early hyperparathyroidism.

Surgical Consultation

Once a diagnosis of primary hyperparathyroidism has been secured, a surgical consultation is advised to figure out if you need surgery or can be safely monitored without surgery. If surgery is indicated, preoperative imaging of the overactive parathyroid gland(s) should be undertaken to see if you may be a candidate for minimally invasive parathryoidectomy.

Ultrasound

Performed easily with a probe on the neck and has no radiation. It can evaluate enlarged parathyroid glands, and also assess the thyroid at the same time.

4-D CT Scan

The “4-D” refers to the fourth dimension – which is very precise timing of the intravenous contrast and the scanning. This test is very accurate and finds parathyroid glands that may hide in uncommon areas such as high in the neck, behind the great vessels, such as the carotid, behind the esophagus, or in the chest. This test requires expertise in performing the scan properly, and interpreting it well. It requires intravenous contrast and does have radiation exposure.

Sestamibi-SPECT Scan

A mild radioactive dye (called sestamibi) is injected into the vein and absorbed by the overactive parathyroid gland. Rotating X-ray scans identify the presence and location of the sestamibi. This test does require injection of the dye and multiple X-rays, and can sometimes be more time consuming.

MRI

MRI is not used routinely for detection of enlarged parathyroid glands, but may be recommended in select patients with previously failed operations for hyperparathyroidism when a CT scan cannot be done, as may be the case in pregnant women.

Arteriography and Venous Sampling

Usually reserved for patients who have undergone parathyroid surgery previously, but now have either recurrent or persistent hyperparathyroidism. This invasive test involves the placement of a tiny catheter in the vein and guided in the neck and upper chest in order to measure blood samples of parathyroid hormone levels at different locations. This can provide a map of where the most parathyroid hormone is found, and helps guide the surgeon to the location of the hidden parathyroid gland.

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When it comes to your care, you want the very best. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our diabetes and endocrinology program is nationally ranked, and the highest ranked program in North Carolina, according to U.S. News & World Report for 2020–2021.

Why Choose Duke

Minimally Invasive Parathyroid Surgery for Primary Hyperparathyroidism
We are one of the few places in the country where surgeons use small, 2- to 3-centimeter incisions to remove the overactive parathyroid gland or tumor under local anesthesia in an outpatient setting. You may go home the same day and experience fewer complications related to anesthesia, including vomiting, nausea and sore throat when compared to conventional parathyroidectomy.

Faster Recovery, Less Pain
Our patients experience fast recovery times, less pain, return to work/life quickly and have minimal chance of experiencing significant side effects such as hoarseness or low calcium levels. Research shows that patients who undergo minimally invasive parathyroid surgery experience excellent long-term cure rates which are comparable to patients who undergo traditional, more invasive parathyroid surgery.

Sophisticated Pre-Operative Imaging
We use 4-D Computed Tomography (CT) imaging -- available at only a handful of centers in the country -- to locate hard-to-find parathyroid glands before surgery. For the rare occasions where parathyroid glands are located in hard-to-reach areas, such as the chest, we work closely with thoracic surgeons using minimal access techniques to remove these glands safely.

Surgical Success Confirmed in the OR
Our surgeons use a 10-minute hormone test during surgery to confirm the success of the operation. Surgeons may also use a gamma probe to detect low-level radioactive tracers that accumulate in overactive parathyroid glands. The probe detects the radioactivity and confirms whether the surgeon has removed the entire affected area.

Parathyroid Tissue Banking (Cryopreservation)
We are one of the handful centers in the country to freeze and bank parathyroid tissue for patients who require the complete removal of their parathyroid glands and have undergone parathyroid autotransplant. If the first transplant fails, the preserved tissue can be transplanted again. This gives you an important safety net.

Special Expertise in Treating Pregnant Women
A diagnosis of hyperparathyroidism during pregnancy can be scary. We specialize in its successful and safe treatment in pregnant women.

Genetic Counseling and Screening
Genetic counseling and screening are available to you and your family members with potentially inherited forms of hyperthyroidism.