Welcome to Northwest Parathyroid
We are a team of physicians dedicated to the
treatment of parathyroid gland disease.
What are parathyroids and what can go wrong?
The parathyroid glands are actually four tiny glands that sit in the lower neck. They are found very near another gland in the neck called the thyroid gland. Although the parathyroid glands may lie very close to the thyroid or even be found inside of it, they have a very different function. While the thyroid regulates energy levels and growth, the parathyroid glands regulate calcium levels in your system.
The parathyroid glands regulate calcium in your body by making more or less of a hormone called parathormone (or PTH as it is also called). The parathyroid glands constantly measure calcium levels in the blood as it flows through them. If the calcium level gets high and is unsafe for your body, the normal glands sense this and decrease or stop their hormone production. This in turn lowers the calcium in your body and all returns to normal. Abnormal glands are unable to do this. They make too much hormone and continue to raise the blood calcium even when it is already very high.
What can go wrong with your parathyroid glands?
When one or more of your parathyroid glands become abnormal it is called hyperparathyroidism. In this situation, your gland (or glands) make too much (“hyper”) parathyroid hormone. Too much hormone raises blood calcium to unsafe levels. High blood calcium causes many symptoms and problems for your body including brittle bones, premature fractures, bone pain, general loss of energy or fatigue, depression, gastric reflux, kidney stones, and high blood pressure. In short, the bodily system has a major malfunction.
Instead of stopping the rising calcium as it should, the parathyroid gland only makes it go higher. This problem occurs because one (more rarely more) of the parathyroid glands stops working with the rest of the body. It develops a growth (also called an adenoma) and swells to a larger size. It no longer senses calcium levels in the blood and instead of listening to what the body needs, just keeps raising the calcium level. Like a “runaway train” the calcium level gets higher and higher and the symptoms and problems you experience get worse and worse. 97% of the time only one of the glands is the culprit. It develops a benign growth called a parathyroid adenoma.
Less commonly (2-2.5% of the time), a person will develop enlargement of all four glands. This is not an adenoma but is called hyperplasia. Even more rare is a condition where an individual will develop enlargement of just two glands, which is called “multiple adenomas”. And finally, much less than 1% of the time, a malignant growth may be found in the abnormal parathyroid.
What are the symptoms of parathyroid gland disease and what is the best treatment?
Parathyroid gland disease causes many problems. At first, individuals may be free of symptoms. But as the abnormality persists symptoms occur and they escalate. These may include:
- premature thinning of the bones (osteopenia)
- severe bone loss (osteoporosis)
- bone fractures
- kidney stones
- high blood pressure
- gastric reflux
- ulcers
- bone pain
- cardiac atrial arrhythmias (rare)
Some people may have had high blood calcium for several years before a parathyroid problem is suspected and identified. Many of these individuals will not have any of the major symptoms just described. In fact, many of these people don’t think they have any symptoms at all! Usually, however, they will have been experiencing some of the more nonspecific symptoms such as:
- memory loss
- low energy
- vague aches and pains
- muscle weakness in the legs
- difficulty with concentration
- feeling “out of sorts”
- fatigue
- depression
Unfortunately, people may often attribute these symptoms to “getting old” or “being out of shape” or “emotional issues” like depression. It is very important that high blood calcium be detected and evaluated. Even a slight elevation of calcium can be an early warning sign that diagnosis and treatment are needed.
Treatment Options
There are two treatment options available to you: a watchful waiting approach or surgical removal.
Surgery is the only cure for primary hyperparathyroidism. Surgical removal is strongly advocated by physicians who frequently diagnose and recommend treatment for parathyroid disease.
If you are reading this section, then you or a loved one has probably been diagnosed with hyperparathyroidism and high blood calcium. With current advanced techniques, parathyroid surgery is very well tolerated and carries few complications. Furthermore, studies have shown that elderly patients enjoy the same benefits from successful parathyroid surgery as younger people do.
How do we identify the abnormal parathyroid glands?
Cervical Ultrasound and Nuclear Scintigraphy (Sestamibi Scan)
The traditional methods for parathyroid imaging are cervical ultrasound (US) and nuclear scintigraphy (sestamibi scan). These two imaging modalities are often used together to allow for identification and localization of the abnormal parathyroid gland. US enables precise anatomic localization and may be very accurate for normally positioned parathyroid adenomas. While the spatial resolution of a sestamibi scan is lower than that of US, it is able to identify parathyroid glands located outside of their normal position (i.e. upper neck or chest) that can be missed with US.
4D CT Parathyroid Scan
Four-dimensional CT has advantages in common to both US and scintigraphy. It provides excellent detail for preoperative localization, while the multiple phases show uptake characteristics that help to differentiate parathyroid lesions from lymph nodes and thyroid nodules.
How is parathyroid surgery usually performed?
Minimally Invasive Parathyroidectomy
Minimally invasive parathyroid surgery refers to the utilization of a small incision on the anterior neck, usually less than 2.5 cm. To select patients for minimally invasive parathyroidectomy surgery, the surgeon needs precise localization of the parathyroid adenoma and to exclude multiglandular disease.
The advantage of pre-operative localization is that it allows the surgeon to directly target a single gland for removal. Some surgeons may also use radio-guided (sestimibi detection with a gamma probe) to aid in adenoma localization during surgery.
Once the abnormal gland has been removed, intraoperative parathyroid hormone levels can be measured to determine if all abnormal glands have been resected. Further gland exploration is usually not needed.
The cure rates of minimally invasive parathyroidectomy surgery and four gland exploration are similar, but minimally invasive parathyroidectomy surgery has the advantages of better cosmetic results, shorter operating time and reduced complication rates.
Four Gland Parathyroid Exploration
Parathyroid glands can sometimes be difficult to find. Additionally, 30 percent of people can have more than one parathyroid adenoma that may not be identified with pre-operative imaging. If your affected parathyroid gland(s) cannot be located prior to surgery, all four of the glands (two on each side of the neck) will be explored during surgery with identification and removal of the abnormal gland(s). While this approach may require a larger incision, in most cases patients are discharged home the same day.
Northwest Parathyroid Physicians
Proliance Surgeons Minor & James (Seattle)
Overview
John D. Burgoyne, MD, is board certified in otolaryngology and specializes in otolaryngology, sinus and nasal surgery, tonsil and sleep apnea surgery, facial plastic and reconstructive surgery, cosmetic surgery, and facial reanimation.
He loves his specialty because of the comprehensive medical and surgical care it allows him to offer his patients. He considers himself a partner with his patients in achieving optimum health, and is dedicated to finding the solution that is the very best for each patient. It is his goal to provide state-of-the-art, personalized care. Dr. Burgoyne believes that his patients deserve nothing less. He speaks both English and French.
Education
- MD, University of Utah School of Medicine
- Residency, University of Utah School of Medicine
- Fellowship in Otolaryngology, Columbia University Medical Center NY Presbyterian
- Board Certified, American Board of Otolaryngology
Associations
- Alpha Omega Alpha Honor Medical Society
- American Academy of Otolaryngology–Head & Neck Surgery
- American Medical Association
- King County Medical Society
- Phi Beta Kappa National Honor Society
- Phi Kappa Phi Honor Society
- Northwest Academy of Otolaryngology
- Washington State Medical Association
Proliance Surgeons Puget Sound ENT (Everett & Edmonds)
Overview
Tyler Kimbrough, MD, is a board-certified otolaryngologist. His clinical focus includes chronic cough, chronic rhinitis, medical and surgical treatment of ear conditions, medical and surgical treatment of hearing loss, mouth and throat disorders, medical and surgical treatment of nasal blockage, nasal and facial fracture, nose bleeds, pediatric specialty care, salivary gland surgery, medical and surgical treatment of sinus conditions and chronic and acute sinusitis, snoring and sleep apnea, swallowing disorders, thyroid and parathyroid surgery, tonsil and adenoid surgery and voice disorders.
Education
- BS, University of Washington
- PhD, University of Washington
- MD, University of Washington School of Medicine
- Residency in Otolaryngology, University of Minnesota Medical School
- Board certified, American Board of Otolaryngology
Proliance Surgeons Bellevue Ear, Nose & Throat (Bellevue & Issaquah)
Overview
Thomas A. Knipe, MD, is a board-certified surgeon specializing in the medical and surgical treatment of adult and pediatric disorders of the head and neck. While practicing all aspects of otolaryngology, he has a special interest in sinus, sleep and breathing disorders and tumors of the head and neck. He is trained in advanced surgery of the sinuses and skull base to bring his patients safe and proven treatments for complex tumors of the skull base and more common sinus and breathing limitations alike. He treats patients with benign and malignant tumors of the head and neck including thyroid, parathyroid and salivary glands and is trained in salivary gland-saving endoscopic techniques to remove salivary stones. In his practice, he takes great care to educate his patients and apply his medical expertise to partner with and guide each one through important medical decisions.
He is committed to serving the world’s poor and underserved through medical and surgical mission work. He travels overseas to perform surgical repair for children and adults with cleft lip and palate, thyroid disease and benign and malignant disorders of the head and neck.
A native of the Seattle area, Dr. Knipe takes the Northwest’s healthy and active lifestyle to heart. He is an avid runner and works hard to keep up with his wife and two daughters. He also enjoys hiking, fishing and competing in ultimate Frisbee.
Education
- MD, University of Washington School of Medicine
- Residency, University of Tennessee Memphis
- Board Certified, American Board of Otolaryngology
Associations
- American Medical Association
Proliance Surgeons Bellevue Ear, Nose & Throat (Bellevue & Issaquah)
Overview
Anh Q. Truong, MD, is an otolaryngologist – head and neck surgeon (ear, nose and throat specialist). He loves his job and he believes that the doctor-patient relationship is a partnership. He enjoys teaching and working with patients as a team. By carefully listening to and educating patients, he hopes to assist them in making the best decision regarding their care.
Dr. Truong provides a wide variety of specialized medical and surgical services in both adult and pediatric ENT. He finds the continual advancement in the field of ENT astonishing and enjoys employing new technology in patient care when appropriate. He practices comprehensive adult and pediatric ENT with a focus on nasal & sinus surgery, endocrine surgery, and voice and throat disorder.
He grew up in the Puget Sound region and returned in 2014 to be close to family and friends. On his free time, he enjoys running, hiking, snowboarding, working on projects in the house and spending time with his wife and daughters. Dr. Truong is also fluent in Vietnamese.
Education
- MD, University of Washington School of Medicine
- Residency, University of California Davis Medical Center
- Board Certified, American Board of Otolaryngology
Proliance Surgeons Bellevue Ear, Nose & Throat (Bellevue & Issaquah)
Overview
Roger S. Zundel, MD, practices general and pediatric otolaryngology, endocrine surgery, head and neck cancer, and otology. He believes listening to his patients is the key to earning their trust. He understands that ensuring a patient feels cared for is as important as his medical expertise. He is an active member of Overlake Hospital’s staff and has served on multiple hospital committees.
Outside of work, Dr. Zundel enjoys skiing, hiking and spending time with his wife and three daughters. He is learning Spanish and classical guitar.
Education
- MD, Unversity of Utah
- Residency, University of Wisconsin
- Board Certified, American Board of Otolaryngology