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Operative technique

There are multiple ways to approach a parathyroid operation, and operative techniques vary by surgeon.

Why do you look at all four parathyroid glands during the operation? Doesn’t that pose a risk to the glands?

Seeing all four parathyroid glands is the best way to ensure that you are removing all of the diseased glands and leaving in normal ones. However, there can be a risk: when you look at all four parathyroid glands (or even attempt to look at all four parathyroid glands), you are creating scar tissue, which could then make future operations more difficult. There is even a risk that during the dis...

Operation Primary HPT Operative technique Cure rate

Why don’t you use intraoperative PTH? Another surgeon I saw said that he uses intraoperative PTH (ioPTH) to confirm that the patient is cured. You said that you do not use ioPTH. Why is that?

I prefer to evaluate all four parathyroid glands rather than rely on intraoperative PTH. Here is why: intraoperative PTH is just not that accurate. Here is the thinking behind ioPTH: a surgeon can remove one parathyroid, often one seen on preoperative imaging, test the PTH level in the blood, then wait 5 to 10 minutes and test again, then wait 5 or 10 more minutes and test again. If the PTH dr...

Operation Operative technique Cure rate Intraoperative PTH

Can I have surgery with a negative scan? I was diagnosed with primary hyperparathyroidism last year, but no one can seem to find a parathyroid tumor. I have had two sestamibi scans, a CT, and ultrasound but they were all negative. My surgeon says he will not operate until something is seen on the scan. I am having bad bone pain and want to get this done. How can we find this parathyroid?

Imaging studies should not be used to determine when to operate. We diagnose parathyroid disease with labs, not with imaging, so we know that you have at least one diseased parathyroid gland. If the diagnosis is clear, then there is no reason to wait to have surgery, as long as you have an experienced surgeon who can evaluate all four parathyroid glands. If you have a surgeon who wants to see t...

Operation Imaging Operative technique

Why do you not use the radioguided technique?

When I was at the Norman Parathyroid Center, every patient received a radioguided parathyroid operation. Now that I have my own practice, I perform the radioguided operation in some patients, but not all. The main reason is that most people do not need a radioguided approach. It is extra radiation that most people do not need. What exactly is radioguided parathyroid surgery? It is referring...

Operation Operative technique

I am set to have surgery for primary hyperparathyroidism in the near future. So far testing has not been able to detect the location of a hyperparathyroid tumor. I have been told that during the exploratory surgery if the parathyroid glands cannot be located, my thyroid will be removed in an attempt to lower calcium levels. I was also told that if a tumor appeared in the future additional surgery would be necessary. I would like to know if the removal of a thyroid is the normal course of action when parathyroid glands cannot be located.

Thanks for writing. The short answer is that removing the entire thyroid is almost never necessary in parathyroid surgery, but occasionally removing a piece of thyroid can help. There is one very specific scenario in which I will remove a piece of thyroid. Here is the scenario: I am performing an operation for primary hyperparathyroidism and have found three normal parathyroid glands, but I...

Operation Postop complications Operative technique

Dear Dr. Boone, I reached out to you earlier this year when I suspected I had parathyroid disease. I have just recently been definitely diagnosed. I am presently researching and planning to have the surgery in the near future. The doctor here in Chicago with whom I consulted uses General anesthesia but I have read that others use a "light" anesthesia (with no intubation required). What type of anesthesia do you typically use when you perform your surgeries? Thank you!

Thanks for asking. Most surgeons use general anesthesia for parathyroid surgery. I use general anesthesia for all patients, and this is what I did when I was at the Norman Parathyroid Center as well. The terms regarding anesthesia can be confusing. "Light anesthesia" is not really a term that physicians use. The major categories of anesthesia are as follows: 1. General Anesthesia: This m...

Operation Operative technique

This question is regarding Direct Visualization of all 4 parathyroids versus radioguided parathyroidectomy. When directly visualizing the 4 parathyroids, is it easy to tell a normal gland versus a hyperactive gland? I'm sure it is easy to tell if one is grossly enlarged but if it is going abnormal (producing too much PTH) but not yet enlarged, can that be seen or can it only detected by the radioactivity? If 2 of the glands are abnormal or will become abnormal, do they usually become abnormal at the same time? The reason I ask this question is that I see you worked at the Norman Parathyroid Center who uses the radioguided method while you prefer the direct visualization method. Do you still run a sestamibi scan before each surgery but simply don't take a sample of each gland to test individually for radioactivity? Is it just a difference in your views on sampling via visual and being able to tell by size or texture or other feature rather than radioactivity and consequential exposure for patients? Since 20% have more than one gland hyperactive, I'm wondering how certain the visualization is or if in certain cases you do test. I see your method is different now from what you did at Norman Center and just wondered why you changed.

Thank you for your question. It touches on several important aspects of parathyroid surgery. I was at the Norman Parathyroid Center for six years, and was the Medical Director when I left to start my own practice. In starting my own center, I took a close look at our practices in Florida and critically evaluated each one. For the most part, the operation that I do here is the same as the one I ...

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