Preventing Complications of Parathyroid Surgery

The Top Doctors explain that the parathyroid gland is a significant part of the endocrine system, which is responsible for secreting parathyroid hormones that control the levels of calcium and phosphate in the body. Humans have four parathyroid glands that rest behind the thyroid gland, hence the name.

Hyperparathyroidism is the term used to describe a condition characterized by increased activity of the parathyroid gland, resulting in the excess production of parathyroid hormones. There are several classifications of this health problem:

1. Primary
This refers to hyperparathyroidism caused by an abnormality or disease in the parathyroid glands themselves, with no other direct cause. Parathyroid cancer belongs to this classification, as mutated cells grow within the glands.

2. Secondary
This type is usually a result of another condition. Among patients with chronic renal failure, hyperparathyroidism may occur as a secondary complication due to the increased amount of calcium in the blood which the kidneys fail to filter.

3. Tertiary
When secondary hyperparathyroidism fails to respond to pharmacologic measures, the disease becomes tertiary hyperparathyroidism. In this state, the parathyroid glands tend to enlarge. This is quite common in patients with chronic renal failure.

4. Quartary
This is an unusually rare result of the removal of the parathyroid glands due to primary hyperparathyroidism. Renal damage also occurs in this state.

The common symptoms of hyperparathyroidism include bone pain, soreness of the muscles, weakness, fatigue and even depression. Because it involves elevation of calcium levels in the blood, muscle twitching and abnormal heart rhythm can also occur. Although surgery is one of the treatments of hyperparathyroidism, the complications are quite risky. Because parathyroid glands are incredibly tiny, it is always a challenge to locate them during surgical procedures. In US, there were about 8,000 parathyroid surgeries performed in 2004 alone. In 2020, at least 100,000 surgeries are expected to be carried out. Unfortunately, 8-19% of these cases have the tendency to suffer from complications like parathyroid gland damage and even surgical errors.

Just recently, the Best Doctors have discovered that the parathyroid glands glow in the near infrared. Since then, it has become a tool for surgeons to identify them during surgical operations. The collaboration of the biomedical engineers and endocrine surgeons at Vanderbilt University brought about this remarkable discovery. Anita Mahadevan-Jansen, professor of Biomedical Engineering and director of the research, stated that parathyroid glands are easily identified because they glow 2-10 times brighter near infrared light.

They have tried it on over 50 patients, and the results were all positive. Even an endocrine surgeon in Ohio State University Medical Center, John Phay, verified the effectiveness of this finding. His only concern was the fact that the lights needed to be dim during the surgery. The origin of this idea belonged to Lisa White, who was a first year resident in Vanderbilt University back in 2007. She tried to look for an easier way to identify thyroid cells from other type of cells. The path to this discovery was difficult, often leading to failed attempts. Eventually, the researchers marked their notable feat and it proved to be a breakthrough in the field of endocrinology.

The Best Doctors report that Endocrinology is a highly complex branch of medicine that focuses on the study and care of the different hormones that make up the endocrine system, as well as the hormones they release. Doctors who are experts in this field are called endocrinologists, and they assess, diagnose and treat the different conditions pertaining to endocrine pathology. Moreover, endocrinologists do the following:
1. Impart client teaching to prevent health conditions involving the endocrine system.
2. Identify, manage and correct patient’s endocrine disorders.
3. Talk to patients about the possible treatment options and disclose any risks involved.

Endocrinologists should be involved in the treatment process of their patients so that they can guide them in the restoration of their well-being. Typical treatments of hyperparathyroidism generally depend on the severity of the condition. Among the most common therapeutic measures include:
1. Regular medical consultations
These are required to monitor calcium and phosphate levels. During check-ups, it is routine to perform some laboratory tests such as blood work and urinalysis.

2. Medications
Calcimimetics comprise a group of drugs that acts to decrease the production of parathyroid hormones. To date, Cinacalcet is the only medication belonging to this group prescribed to patients with hyperparathyroidism.

3. Surgery
Surgery is highly recommended because it cures 95% of most cases. However, patients are forewarned about certain risks. It is for this reason that patients are asked for consent to the procedure before anything else. Generally, endocrinologists determine the best therapeutic action, and surgery will be the best option if the benefits outweigh the risks.

Accordingly, the Top Doctors reminds us that surgery is the best option for most patients with hyperparathyroidism. Unfortunately, the complications associated with this procedure are too risky. With the discovery of the parathyroid gland’s unique characteristic when exposed to infrared light, the complications will be prevented and the risks significantly reduced. Because of this latest finding, surgeons and patients will be more confident in this method of treatment.

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