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What is the best treatment?

There are two treatment approaches available to you.

  1. A watchful waiting approach: ask a lot of questions if this is recommended to be sure its best for you.
  2. Surgical removal

Surgical removal is strongly advocated by the physicians who frequently diagnose and recommend treatment for parathyroid disease. If you are reading this section then you or a loved one has likely been diagnosed with hyperparathyroidism and high blood calcium.

As a 2005 American Association of Clincal Endocrinology position paper states, the abnormal parathyroid should be removed. It can be removed using a minimally invasive radioguided parathyroid surgery. Many parathyroid surgeons still perform an older form of parathyroid surgery. The older procedure is involved and has greater anesthesia needs because it lasts longer. It requires that a longer incision be made and that a drain be placed in the neck. This procedure also necessitates a hospital stay. Parathyroid problems are rare and some surgeons may only encounter them a few times a year or even every few years.

The minimally invasive parathyroid surgery is the best way to address your parathyroid problem. It involves a tiny incision (as small as one inch) on the neck. Anesthesia needs are less and can be delivered via a special form of mask. Because a special probe is used to guide decision-making during surgery, the procedure is extremely short compared to traditional parathyroid surgeries.

A small piece of tape is applied to the incision and you can go home after the procedure. Many people resume normal activities that day although not all are ready for this. Some people may elect to use a light pain medication but many prefer Tylenol or over-the-counter pain relievers only.

The most common scenario is:

  • arrive morning of surgery
  • sestamibi injection to help localize the abnormal gland
  • brief anesthesia to maximize your comfort
  • tiny neck incision (as small as one inch)
  • gland removal
  • small band-aid on incision
  • instruction for calcium replacement for “hungry bones”
  • over-the-counter or mild narcotic pain relievers
  • head home
  • may slowly resume normal activities that day

The morning of surgery you will get an injection of something called sestamibi. This is what you probably already received when you had a sestamibi scan to help your doctor diagnose your problem. Intravenous sedation allows you to become completely comfortable so that surgery can be brief and very safe. The incision is made and the abnormal gland located and removed. The probe may help find and confirm that the gland is the abnormal one.

Extensive surgery to “check all the glands” is not required. A long wait for you under anesthesia, for the results of confirming blood tests (intraoperative parathormone blood levels) are likewise generally avoided. For surgeons who do this minimally invasive procedure frequently, the cure rate approaches 99%! You will rest in the recovery room until all sedating effects of the medication are gone. You are then released to recover fully over the next several days at home.

Following surgery, the bones are “hungry” to recover the calcium they have lost while the diseased parathyroid was present. You will be sent home with instructions to take calcium to help recover any bone strength that has been lost.

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Polyclinic • 904 7th Avenue • Seattle, WA 98104
206-860-2346 • FAX 206-357-5041