Since parathyroids are glands of the endocrine system, we can detect disease in these glands by measuring the appropriateness of their hormone production.

Under normal conditions, a normal calcium level will be associated with a normal parathyroid hormone level. Also under normal conditions, a low serum calcium level will be associated with a high parathyroid hormone level; and a high calcium level will be associated a with low parathyroid hormone level. These are all appropriate ways in which a parathyroid gland will react to calcium which is circulating in the blood as the parathyroid glands attempt to regulate calcium in the narrow "normal" range. A better explanation of the normal function of parathyroid glands is covered in more detail on our "function" page. thyroid parathyroid disease tumor hormone calcium
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Hyperparathyroidism is relatively easy to detect because the parathyroid glands will be making an inappropriately large amount of parathyroid hormone in the face of an elevated serum calcium. This is straightforward and simple to measure. Another way to confirm this diagnosis is by measuring the amount of calcium in the urine over a 24-hour period of time. If the kidneys are functioning normally they will filter much of this calcium in an attempt to rid the body of calcium leading to an and an abnormally large amount of calcium in the urine. Measuring calcium in the urine, however, is an indirect measure of parathyroid activity and is only accurate in about 25 to 40 percent of the time. The most accurate and definitive way to diagnose primary hyperparathyroidism is by showing an elevated parathyroid hormone level in the face of an elevated serum calcium.

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The only two choices available for patients with primary hyperparathyroidism are to do nothing, or to have surgical removal of the diseased parathyroid gland (or infrequently, more than one diseased parathyroid gland). Some physicians will elect to not refer their patients for an operation if they have a mild form of primary hyperparathyroidism. Much of this management style stems from the fact that standard parathyroid surgery in the past required the use of general anesthesia and was a major operation. THIS IS NOT GOOD ADVICE! Parathyroid disease will ALWAYS get worse. It will NEVER go away on its own. Remember, it is caused by a tumor that has developed from one of the parathyroid glands. Waiting will just allow the parathyroid tumor to grow bigger. It will NEVER get better on its own. It will NEVER stay the same.

The standard "Old Fashioned" operation that is still performed by nearly all general surgeons and ENT surgeons can be dangerous, thus everywhere you read you will see people advise you to "pick an expert surgeon". This is because the old fashioned operation requires that the surgeon dissect all the structures in your neck to "find" the bad parathyroid gland. All of this dissection increases the chances of bleeding and requires general anesthesia and a large incision. An inexperienced surgeon also has a much lower rate of finding the tumor... Most importantly, however, is that this big operation performed by an inexperienced general surgeon has a risk of injury to the voice box nerve of about 2-5%. Sounds like a pretty low risk??? Well, if the nerve to your voice box is injured, then you will likely never be able to talk again. Trust us, this will ruin your life! Furthermore, if this surgeon is inexperienced and he/she operates on both sides of your neck and injures the voice box nerve on BOTH sides, then you will require a tracheostomy just to be able to breathe, and of course, you can't talk!  YES, we are referred patients to our clinic about every 4 DAYS that cannot talk, and a patient that has a tracheostomy comes seeking our help about every 3-4 WEEKS. Finally, AT LEAST ONCE PER DAY we get a referral for a patient that is not cured, thus needing a second operation, after an inexperienced general surgeon or ENT surgeon operated on them.

HOWEVER, if you find an expert surgeon, then these operations are not nearly as "involved" as they once were. An expert parathyroid surgeon (one that performs at least 100 of these operations per year) will have a MUCH lower rate of complication and will usually cure you. Some new techniques of radioguided parathyroidectomy (the MIRP operation) is DRAMATICALLY better than the old operation. The MIRP operation typically takes less than 20 minutes and you can go home in an hour!

HOW CAN YOU TELL IF YOUR SURGEON
IS AN EXPERT AT PARATHYROID SURGERY?

Simple, ask these questions to tell if your surgeon is an expert and is up with the latest and greatest available to you in 2005. Listen to their answers... they should be clear and concise, look for avoidance or excuses...

The answer to the FIRST 3 questions SHOULD BE YES...
 if they say NO to ANY of these, then go somewhere else.

1. Do you perform MORE THAN 50 parathyroid operations per year? (do not let them count thyroid operations, it is NOT the same thing).

2. Are you  trained in Mini-Parathyroid surgery? Do you routinely perform Mini-parathyroid surgery at least 85% of the time?

3. Do you check the status of the parathyroid glands in the operating room? (by measuring radioactive ratios of the glands or using PTH assays in the operating room).

The answers to the last 4 questions should be NO. 
If they say YES, go somewhere else!

4. Do you put a drain in all or most of your patients to drain blood? (experts almost never do this!)

5. Do you require most or all of your patients to spend the night in the hospital after the operation? (experts send home nearly 100% of their patients... find another doctor!).

6. Do you use a nerve stimulator to help you find the voice box nerve? (this is a sign of low experience... someone who is unsure of the anatomy... RUN!!).

7. Do you require that every patient is intubated with "general endotracheal anesthesia"?