Outpatient treatment for hyperparathyroidism

Hyperparathyroidism often requires surgical treatment to remove the abnormal parathyroid gland or glands. The goal of surgery is to bring the parathyroid hormone levels and calcium levels into the normal range. There are two main risks of parathyroid surgery in addition to the general risks of every surgery. If all or nearly all of the parathyroid tissue is removed, hypoparathyroidism results and low calcium in blood will cause low calcium symptoms such as irregular heart beats or muscle spasms. Secondly, the nerves that control the vocal cords can be damaged. Therefore the surgery was traditionally done as an inpatient, meaning that the patient would have surgery and then remain in the hospital at least one night for close monitoring of calcium levels and parathyroid hormones. Advances in technology are allowing more precise and safer surgeries, which enable selected patients to go home hours after the surgery is completed.

If your doctor is recommending surgical treatment of hyperparathyroidism, he or she will likely order a sestamibi scan. This scan uses a very small amount of a radioactive substance. This substance is absorbed by the abnormal parathyroid gland or glands and enables them to be seen on x-ray scanning. In most people, there is only one abnormal parathyroid gland. If the sestamibi scan is successful in locating the gland, the patient is a candidate for outpatient surgery. In come cases, more than one parathyroid gland may be abnormal or the sestamibi scan may not show a clear picture. In these cases, the surgeon will likely have to perform a traditional surgery and keep the patient in the hospital overnight to monitor calcium levels.

Other technological advances that have made parathyroid surgery more effective and safe are radioguided parathyroid surgery, monitoring of parathyroid hormones intraoperatively and nerve monitoring. The same radioactive material that is given for a sestamibi scan also allows the surgeon to perform radioguided parathyroid surgery. In radioguided parathyroid surgery, a probe that detects small amounts of radiation is used as a guide to identify the abnormal gland. Intraopeartive monitoring of parathyroid hormones is a test done by a blood draw following removal of the suspicious glands. If the parathyroid hormone level returns to normal, the surgeon can be confident that all of the abnormal tissue has been removed. If the level falls to zero or nearly zero, the surgeon may need to replace some of the parathyroid tissue to prevent low calcium levels from occurring. Nerve monitoring systems are now used in every case of parathyroid and thyroid surgery to enhance the surgeon’s ability to find the nerve and to keep the nerve safe from injury.

The surgeon must determine which patients are candidates for outpatient surgery and which patients require an overnight stay in the hospital. This decision will be determined not only by the preoperative tests, such as the sestamibi scan, but the intraoperative findings also. All patients will need a series of blood tests following surgery to monitor parathyroid hormone levels and calcium levels. Follow-up appointments at the doctor’s office are also important to monitor progress and symptoms.