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As
with thyroid surgery, the surgeon’s experience and expertise are highly valued
in the treatment of parathyroid disease. Dr. Smith performs between 80-100
parathyroid operations each year and many of these surgeries can be performed
through an incision that is less that one inch long and is done on an outpatient
basis. This Minimally Invasive Parathyroid Surgery (MIPS) can be done in almost
all patients with parathyroid disease. The outpatient surgery on parathyroid
glands allows the patient to recuperate in the comfort of his/her own home. Dr.
Smith was one of the first surgeons in the area to extensively use
Intraoperative Parathyroid
Hormone Monitoring. This technique
along with minimally invasive parathyroid surgery gives the patient the greatest
opportunity for cure with the least invasive surgical procedure.
Hyperparathyroidism
Primary
hyperparathyroidism is a disease state that is manifested by an increased serum
level of calcium and parathyroid hormone (PTH). The disease can affect any
person between the ages of infancy til death. It is most common between 50 and
60 years of age and does have a three to one ratio in women versus men. Most
patients are diagnosed with hypercalcemia on a routine physical examination.
Further work up will then lead to the discovery of an increased PTH level and
diagnosis of primary hyperparathyroidism. Symptoms involved in
hyperparathyroidism may range from fatigue, memory loss, joint and muscle aches
and pains, renal stones, and osteoporosis or softening of the bones.
Calcium in our body is found in the blood stream and bones and, when our
parathyroid glands are functioning normally this balance is maintained. When
hyperparathyroidism exists too much PTH causes too much calcium to be removed
from our bones and put into our blood stream, thereby, creating the symptom
complex mentioned above.
The most common
cause of hyperparathyroidism is a benign enlargement of one parathyroid gland
and this is referred to as a parathyroid adenoma. The second most common cause
of hyperparathyroidism is referred to as parathyroid hyperplasia. This condition
makes up approximately 15% of patients with primary hyperparathyroidism and in
this condition all four parathyroid glands are enlarged. Carcinoma of the
parathyroid glands is an extremely rare condition and occurs in less than 0.5%
of cases.
During the past 10
years pre-operative parathyroid imaging has been developed to a much higher
degree of specifity than was ever thought possible. Pre-operative sestimibi
parathyroid scans are now routinely done on all patients and can successfully
predict the location of the abnormal parathyroid gland in 70-80% of patients.
Dr. Smith was also
one of the pioneers of the use of Intra Operative Parathyroid Hormone Monitoring
(IOPTH) in this area of the country. This technique is used in combination with
the Minimally Invasive Parathyroid Surgery to assure the greatest accuracy in
the outcome of the patient’s parathyroid exploration. IOPTH monitoring and
Minimally Invasive Parathyroid Surgery has revolutionized the treatment of
hyperparathyroidism and Dr. Smith has been on the forefront of these new and
exciting techniques.
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