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cirugía endocrina paratiroides
cirugía endocrina paratiroides

Endocrine Neck Surgery

Endocrinology and nutrition

Obesity unit

Consultants:

Parathyroid

cirugía tiroides

Endocrine Neck Surgery Unit

Treatment of hyperparathyroidism (symptomatic or asymptomatic, uni or multiglandular, primary or secondary, sporadic or hereditary cases). New technology including PET-colina are available in order to localize pathological glands. Selective surgery through minimally invasive approach or bilateral exploration should be done with tailor made philosophy according with European endocrine guidelines. We believe in the possibility of improving the quality of life in lots of cases with hypercalcemia and nephrolithiasis, osteoporosis or neurocognitive symptoms even in elderly patients.

 
 

What are the parathyroids and what type of patients will benefit from surgery to these glands?

The parathyroids are four small glands with the size of a grain of rice. They are found in the neck behind the thyroid gland and their function is to regulate calcium metabolism. When one or more parathyroid glands function inadequately, a decrease in bone calcium (with osteoporosis developing), an increase in urine calcium, (causing renal colic) or an increase in blood calcium (increasing cardiovascular risk or inducing neurocognitive symptoms such as depression, anxiety, difficulties concentrating or sleep problems) may occur.
 
Everyone who has raised calcium hormone (PTH) in the blood will benefit from surgery to cure or alleviate symptoms, or even to help prevent them.

What is parathyroid disease?

When the parathyroid glands function inadequately, the diagnosis is called hyperparathyroidism. It may be primary, or secondary (in patients with renal problems, malabsorption, treatment with lithium or vitamin D deficiency). The majority of times it is sporadic but occasionally it is hereditary.

What is the scar like following parathyroid surgery?

In 90% of cases, when only one gland is involved which has been located prior to surgery, there are selective techniques meaning the scar in the neck is lateral and only measures 1-2 cm, achieving very good aesthetic results. In cases where more than one gland is affected, the scar may need to be in the centre of the neck and measure around 3-4 cm, so that the 4 parathyroid glands can be assessed to solve the metabolic problem, but sutures facilitating minimal scarring are used.

Which is the most innovative form of preoperative imaging to locate disease of the parathyroid glands?

According to European quality standards, prior to thyroid surgery an anatomical study (US, CT, MRI) with a further metabolic study (gammagraphy) are required before deciding on the surgical strategy. In the last few years SPECT-CT has been developed which unifies the two tests. The newest test of all, for the most difficult cases, is the PET-choline scan which has a higher sensitivity than other tests. HC has the facilities to perform PET-choline scans, highly advantageous in locating these diseased glands prior to surgery. This, carried out in an exclusive environment, where we have time to dedicate to our patients, in green spaces to help promote recovery, makes HC a good place to undergo parathyroid surgery.

How many days are required in hospital following surgery?

Usually only one night in hospital is required, however we adapt to each patient’s requirements.

What are the results of parathyroid surgery?

In expert hands, the cure rate of surgery is over 95%. Surgical results are very satisfying because we can improve the quality of life of those patients with osteoporosis or renal calculi and prevent future cardiovascular problems. It is remarkable to see how women after the menopause, or elderly patients who are already resigned to having bone pain memory loss, loss of concentration, sleep disturbances or depression, improve after this type of surgery.

 

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