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Surgery

Endocrine Surgical Unit brings leading experience and methodology to parathyroid disease treatment

10/28/2009

Endocrine SurgeryThe UCLA Endocrine Surgical Unit is dedicated exclusively to thyroid, parathyroid and adrenal disease, offering unrivaled ability and experience along with the latest diagnostic and surgical methods and equipment.

Research confirms that experience counts when it comes to surgical treatment of parathyroid disease. Both in terms of accurate localization and surgery, centers like UCLA that evaluate and treat these patients with great frequency achieve the best outcomes.

Parathyroid disease

The parathyroid glands — four sunflower-seed-sized glands located behind the thyroid gland — control the body’s calcium levels. Primary hyperparathyroidism is characterized by high parathyroid hormone (PTH) levels in the presence of high or high-normal calcium levels. This ongoing pathologic process causes a net loss of calcium from the skeleton into the bloodstream and urine. Complications include kidney stones, osteoporosis, musculoskeletal pain, possible cardiovascular disease, and neuropsychiatric symptoms such as fatigue, anxiety, memory loss and depression.

Paratyroid disease affects approximately 1 percent of the adult population, and occurs three times more often in women than men. The risk of parathyroid disease increases with age, particularly after age 55. About 3 percent of postmenopausal women have the disorder, often complicating menopausal bone density loss.

Diagnosis and treatment

Increased understanding of the multiple adverse health effects of primary hyper-parathyroidism has prompted national expert groups to recommend parathyroid surgery for all patients in whom the biochemical diagnosis has been established.

Elevated calcium levels related to parathyroid disease are typically detected during routine blood testing. Primary hyperparathyroidism should be suspected if calcium and intact PTH levels are both elevated. Ultrasound is a useful test in diagnosing parathyroid adenomas — benign tumors of the parathyroid glands that often cause primary hyperparathyroidism — though the sensitivity is highly operator-dependent. A parathyroid scan with sestamibi is a very sensitive test for detecting and localizing parathyroid disease, especially when combined with low-dose CT and 3-dimensional imaging (SPECT/CT).

More than 90 percent of patients undergoing surgery for primary hyperpara-thyroidism are eligible for minimally invasive surgery, which is associated with faster recovery and less scarring. People in good general health can usually be discharged within four hours of their procedure. Those not eligible for the minimally invasive procedure often have multiple gland parathyroid disease.

At UCLA, almost all patients are given the choice between general anesthesia and light sedation in combination with a local anesthetic. The minimally invasive procedure typically lasts less than 30 minutes and involves a scar measuring 1.5 centimeters — the diameter of a penny — that is hidden within natural skin folds. Intra-operative PTH measurements can determine success of the procedure within minutes of removal of the diseased gland.

Myths about parathyroid surgery

Myth: Radio-guided parathyroid surgery improves outcomes. Multiple independent studies have found no benefit to this technique, leading nearly all expert centers to abandon it. UCLA surgeons favor pre-operative and intra-operative ultrasound for real-time parathyroid imaging.

Myth: Many patients are too elderly and/or frail to be candidates for parathyroid surgery. In its modern form, parathyroid surgery is very well tolerated and carries few complications. Studies show that elderly patients enjoy the same benefits from successful parathyroid surgery that younger individuals do.

Myth: There is no standard definition of “minimally invasive” parathyroid surgery. Though many centers may claim to offer minimally invasive procedures, only a minority truly meet objective criteria for the technique. The term “minimally invasive” is reserved for parathyroid surgery involving an incision measuring less than 2.5 cm in length. At UCLA, an incision length of 1.5 centimeters is used.

Experience yields better outcomes

“In expert hands, minimally invasive parathyroid surgery is associated with a greater than 98 percent cure rate and less than 1 percent surgical complication rate,” explains Michael Yeh, assistant professor of surgery and medicine, “This compares with success rates of only 70 percent among less experienced surgeons.”

Similarly, diagnostic tests to localize diseased parathyroid glands are 90 percent accurate when performed by experienced multidisciplinary teams such as UCLA’s, compared to 30 to 70 percent in less experienced hands. Successfully locating the diseased gland from among the four parathyroid glands is the key to being able to offer minimally invasive treatment.

While UCLA surgeons have experience with nearly all parathyroid surgical techniques, Dr. Yeh states, “We favor the focused lateral mini-incision technique, which involves an incision length of 1.5-2.0 cm. In our opinion, this method provides the most direct access to the parathyroid glands, minimizes tissue injury, and has superior cosmetic results.”

Participating Physicians

Michael Yeh, M.D.
Director, Endocrine Surgery
Assistant Professor of Surgery and Medicine (Endocrinology)

Christiaan Schiepers, M.D., Ph.D.
Professor of Molecular and Medical Pharmacology
Nuclear Medicine

Christopher Loh, M.D.
Assistant Clinical Professor
Division of Interventional Radiology
Department of Radiology

Mary Maish, M.D., MPH
Assistant Professor of Surgery
Division of Cardiothoracic Surgery

Contact Information
310-206-0585 Information and appointment scheduling
310-825-0189 Fax
http://www.endocrinesurgery.ucla.edu





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