Radioguided surgery for hyperparathyroidism

Elevated calcium in blood is never normal and almost always means parathyroid disease (the parathyroids are glands in the neck that function to regulate calcium). High calcium levels in blood is a sign that there is elevated calcium levels throughout the body. Elevated calcium interferes with the function of nearly every cell in the body and causes a multitude of problems and symptoms such as brittle bones, abdominal pain, kidney stones and heart disease.

Surgical removal of the abnormal parathyroid gland or glands is the best treatment for hyperparathyroidism and correction of elevated calcium. Traditionally, parathyroid surgery involves a long incision across the front of the neck and exploration of the tissues on both sides of the neck to locate and evaluate all four parathyroid glands. Parathyroid glands are small and sometime difficult to locate. Radioguided surgery and sestamibi scanning are techniques that have been developed to facilitate parathyroid gland identification, making surgery faster and safer.

A sestamibi scan is a radiological image of the thyroid glands. This test is performed in the radiology department and involves taking a small amount of a radioactive solution. This solution is taken up by the abnormal parathyroid glands, allowing them to be seen on a scan. This test will often allow the surgeon to get an idea of where the abnormal parathyroid gland or glands are located in the neck.

The same radioactive solution that is used for sestamibi scanning enables radioguided surgery. Radioguided surgery begins in the same fashion as traditional parathyroid surgery, with an incision being made in the neck. An instrument called a gamma probe is then used. This gamma probe detects the radioactivity that was absorbed into the abnormal parathyroid gland, making it easier to locate abnormal parathyroid glands. This is a new technique in parathyroid surgery. Dr. Michael Friedman has been involved in research regarding the use of this technique.

Radioguidance is often used during minimally invasive surgery to facilitate the localization of the abnormal parathyroid glands. Minimally invasive surgery offers the advantages of not only a smaller incision, but also decreased pain as well. Minimally invasive surgery can be done under local anesthesia rather than general anesthesia in selected patients. All surgeries have risks such as bleeding and infection. Parathyroid surgery, both minimally invasive and traditional, also carries the risk of damage to the nerves that control the vocal cords and the risk of permanent low calcium levels, requiring supplementation.