Once the diagnosis of 1°HPT is made surgery should be considered. Some elderly patients with mild disease, who are completely asymptomatic and are without evidence of heart, kidney or bone disease may be considered for observation (AAES Statement on the treatment of 1°HPT). Most patient are offered surgery as it is the only curative therapy. …Read More »
Author: Dr. Kirk Faust
Secondary Hyperparathyroidism (2˚HPT)
Secondary hyperparathyroidism (2°HPT) is overactive parathyroid glands due to extra – parathyroid factors that stimulate otherwise normal parathyroid glands to be overactive. The two most common causes are kidney failure and vitamin D deficiency. 2°HPT is characterized by low normal or normal calcium levels and elevated PTH levels. Remember, 1°HPT is characterized by elevated calciumand …Read More »
Treatment of 2˚HPT
Once the decision for surgery has been made, a standard neck exploration to evaluate all 4 parathyroid glands is performed. Two approaches are used. One is a 3 and 1/2 gland resection. With this operation all parathyroid tissue except a portion of one gland is removed with the hope of reducing the PTH secretion to …Read More »
Tertiary Hyperparathyroidism (3˚HPT)
3°HPT develops in some cases of long standing 2°HPT when prolonged hypocalcemia causes the development of independently functioning parathyroid glands. Hypercalcemia develops and again the PTH levels are significantly elevated. This situation occurs most commonly in patients with chronic renal failure. The classic situation occurs when a patient with kidney failure (and 2°HPT) receives a …Read More »
Risk of Parathyroidectomy
The risk of parathyroid surgery is minimal. The risk of a serious complication is significantly less than 1%. Like other surgery, there are risks with anesthesia, bleeding and infection. These are quite small. As with thyroid surgery there is a risk of voice injury. This is rare. The superior parathyroid glands may be very close …Read More »
Post-Op Care After Parathyroid Surgery
Patients recover very quickly after parathyroidectomy, After surgery for 1°HPT most patients go home the same day. However those that have 3 and 1/2 gland resections (subtotal parathyroidectomy) are usually observed overnight because of the risk of hypocalcemia. There is very little pain. All wounds are closed with skin glue and the patient may shower …Read More »
Follicular Thyroid Cancer
FTC is the second most common type of thyroid cancer. FTC is more common in areas of iodine deficiency. It is relatively uncommon in the US, representing < 15% of all thyroid cancer. It is more common in women than men. It usually presents as an asymptomatic mass. Unlike PTC it is less likely to be …Read More »
Hurthle Cell Cancer (HCC)
Hurtle cell cancer is thought to be a variant of FTC. Overall the same diagnostic issues exist and the treatment approach is similar. Hurthle cell cancer may be more aggressive than FTC with spread to the lungs being more common. Hurthle cell cancer may not respond to RAI as well as PTC or FTC. For this reason some …Read More »
Medullary Thyroid Cancer (MTC)
Medullary Thyroid cancer(MTC) is considered with other well differentiated thyroid cancers, but is different in that the cells of origin are the para-follicular cells. These are cells in the thyroid gland that are not involved in making thyroid hormone. Para-follicular cells make a hormone called calcitonin. It may play a role in calcium regulation. The importance of …Read More »
Fine Needle Aspiration (FNA)
FNA is a common procedure done in the office with local anesthesia. It is the best way to diagnose thyroid cancer. Its accuracy approaches 95%. A small amount of local anesthetic is injected into the skin and the underlying tissues. This is the most uncomfortable part of the procedure. A small needle is inserted into …Read More »