November 4, 2014 By Peter M. Mowschenson, MD

Asymptomatic Patients?

As many as 30% of patients only realize they had symptoms such as fatigue and muscle aches once they have had surgery.

Incision 4 Months
This is an untouched photo of one of my patients at four months. I have many other photos with similar results. This early scar will continue to fade for two years. < Back to Parathyroid Surgery
Incision
There is much written about tiny incisions and minimally invasive surgery for hyperparathyroidism. The important issue is to have successful surgery. The final cosmetic result is excellent and within a year or two the incision is barely noticeable. I tailor the incision to the situation. < Back to Parathyroid …
4D CT Imaging
This is the latest test available and it can be extremely helpful when the Sestamibi scan and ultrasound do not show the enlarged parathyroid (s) < Back to Parathyroid Surgery
Preop Imaging
If performed by an experienced ultrasonographer this test can be very helpful in locating the enlarged parathyroid (s). < Back to Parathyroid Surgery
Localization Studies
There are different approaches to parathyroid surgery. I use the approach used by the vast majority of endocrine surgeons in the US. Localization helps a minimally invasive focused operation to be performed along with intraoperative PTH testing. < Back to Parathyroid Surgery
Symptom Improvement Rate
Patients often ask how soon they can expect to feel better These are rough guidelines. Within one week: Fatigue Bone and Joint pain Delayed: Muscle aches Sleep problems Heartburn < Back to Parathyroid Surgery
Effect of Surgery
And the good news is that surgery is very successful in treating these symptoms. < Back to Parathyroid Surgery
Muscle Strength
More evidence showing that muscle strength can improve after surgery for hyperparathyroidism. < Back to Parathyroid Surgery
GERD 6 months after PTx
Heartburn may be significantly improved after surgery for Hyperparathyroidism Preoperative Postoperative P value Overall score 12.5 ± 1.3 4.5 ± 0.9 <.0001 Severity 2.01 ± 0.20 0.84 ± 0.14 <.0001 Satisfaction 2.16 ± 0.25 0.55 ± 0.14 <.0001 Reiher Surgery 2012 < Back to Parathyroid Surgery
Kidney Stones
Good news for patients who have the operation for kidney stones. The risk is very much reduced as shown in this graph. < Back to Parathyroid Surgery
Decreased Fracture Risk
This graph compares the fracture rate in patients who had parathyroidectomy compared with those who did not. Parathyroid surgery reduced the risk of fracture. The 10-year fracture-free survival was 73% in those who underwent parathyroidectomy compared with 59% in those who did not. < Back to Parathyroid Surgery
10 Year Prospective Study – Effect of Surgery on Bone Density
This study shows that bone density improves after parathyroid surgery, which is one of the main reasons to recommend surgery. The improvement is over a few years. < Back to Parathyroid Surgery
PTx in Octogenarians
This is a real problem for the elderly. Many elderly patients have hyperparathyroidism with exactly the same symptoms as younger patients. The graph shows patients younger and older than 80 years. However many older patients are not referred for surgery and yet they can benefit immensely. < Back to Parathyroid …
Blood Changes and Symptoms Not Related
This is a very important slide because it may explain why some patients are not referred for surgery. It shows that a patient can have equally bad symptoms if their blood level changes are mild or severe. Some physicians do not refer patients because they appear to only have mild …
Common Symptoms of Hyperparathyroidism
This chart shows the wide variety of symptoms that patients with hyperparathyroidism may have. The red bars show patients and the green are comparisons with healthy patients. This is a common way of reporting result in scientific journals. < Back to Parathyroid Surgery
An elevated blood calcium is detected frequently because of routine blood testing.
An elevated blood calcium is detected frequently because of routine blood testing. However even when the blood calcium is elevated many patients are not investigated to exclude hyperparathyroidism and the diagnosis may be delayed for years. A recent report from the Cleveland Clinic showed that only about 1% of patients …
American Association of Endocrine Surgeons
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