At Mount Sinai, our surgeons specialize in treating endocrine conditions, such as disorders of the parathyroid glands. We use state-of-the art pre-operative imaging, surgical findings, and intraoperative parathyroid hormone testing to determine the extent of parathyroid disease in order to provide the most effective treatment. As needed, we identify the condition of each parathyroid gland and treat what we find using local anesthesia whenever possible. Our underlying principle is to perform the least amount of surgery possible to cure you of parathyroid disorders. We perform hundreds of parathyroid operations each year assuring that you have the most experienced team treating you.
About Parathyroid Glands
Positioned behind the thyroid gland located in your neck, your four parathyroid glands produce parathyroid hormone (PTH) which maintains calcium and phosphorous levels in your body for the health of your bones, kidneys, and gastrointestinal system. When the parathyroid glands produce too much PTH, the regulation of your body’s calcium metabolism is disrupted, leading to high blood calcium levels. Parathyroid conditions tend to be benign and only rarely are the conditions found to be cancerous. Parathyroid disorders may be inherited, so it is important to know your family’s medical history.
Parathyroid Conditions We Treat
We have extensive experience treating disorders involving the parathyroid system, which may include benign conditions such as hyperparathyroidism, persistent and recurrent hyperparathyroidism.
Overproduction of the parathyroid hormone (PTH) creates a condition known as hyperparathyroidism, which causes calcium from the bones to elevate the level of calcium in your blood, kidneys, and intestines. Rarely, cases of hyperparathyroidism may be associated with parathyroid cancer. There are two main types of hyperparathyroidism:
- Primary hyperparathyroidism—characterized by overproduction of PTH by the parathyroid glands that raises levels of calcium. We diagnose this condition by measuring your blood calcium, PTH, and Vitamin D levels. We may also require 24-hour urine collection for calcium and bone density studies to diagnose your condition.
- Secondary hyperparathyroidism—characterized by having enlarged and overactive parathyroid glands, a secondary condition is caused by another condition, such as kidney failure or vitamin D deficiency. Rarely, hyperparathyroidism may be caused by aluminum poisoning, malnutrition, rickets, or conditions that make it difficult for the body to break down vitamin D or phosphate.
Our surgeons may perform minimally invasive parathyroid surgery under local anesthesia to treat your hyperparathyroidism. The procedure involves removing of one or more of your body’s four parathyroid glands. Minimally invasive techniques are possible thanks to our surgeons’ use of advanced imaging to locate abnormal parathyroid glands. Through an ultrasound examination, your surgeon can see your enlarged parathyroid gland and no additional imaging is required. If the ultrasound is negative, your surgeon may obtain a parathyroid CT scan or parathyroid MRI, both of which need to be performed at Mount Sinai due to the specialized nature of our imaging protocol. We also analyze the parathyroid hormone levels during surgery in the operating room to determine that the surgery is complete.
Once the result of surgery is confirmed by the parathyroid blood test, the operation is completed. Just one to two hours after this procedure, 95 percent of our patients are able to go home.
Persistent and recurrent hyperparathyroidism
Mount Sinai’s endocrine surgeons treat persistent and recurrent hyperparathyroidism using state-of-the art tools in the operating room including intra-operative parathyroid hormone monitoring and laryngeal nerve monitoring to protect the muscles that support your larynx, the air passage to the lungs that holds your vocal cords.
- Persistent hyperparathyroidism—the initial parathyroid operation was not successful in curing the patient.
- Recurrent hyperparathyroidism—the overactive parathyroid condition returns greater than six months from the initial parathyroid procedure.
We recommend additional testing to identify the exact location of your diseased parathyroid. Based on those results, we will provide you with a comprehensive plan outlining your treatment options that includes what you can expect during your recovery.
A second operation will most likely be necessary to cure recurrent and persistent conditions of hyperparathyroidism.
Parathyroid Treatments We Provide
To plan for a minimally invasive approach to your treatment, we perform preoperative localizing studies so that your surgical team will have the information they need about the location of your abnormal parathyroid gland before surgery. You will undergo a parathyroid ultrasound during your consultation with us. We may also perform other localization studies, which your doctor will discuss with you, all with the goal of ensuring your procedure is as safe and effective as possible.
Parathyroid surgical procedures
Surgery is often the best way to treat parathyroid conditions, including hyperparathyroidism. Once your diagnostic studies are complete, your surgeon will know how best to map out your course of surgical care. We have considerable expertise in performing parathyroid operations under local anesthesia using the latest minimally invasive techniques. At Mount Sinai, our goal is to perform the least amount of surgery possible to cure you of your condition, and we use the following types of minimally invasive procedures to do so:
- Mini incision, targeted parathyroidectomy under local anesthesia—a very small incision is made in a natural skin crease of the neck
- Video endoscopic parathyroidectomy—a very small incision is made in the lower neck with the operative area lit and magnified for the surgeon
- Remote access endoscopic parathyroidectomy—small incisions are made in a remote location (oral cavity, chest wall or axilla) to allow for use of a camera and endoscopic instruments to perform the parathyroid surgery
- Bilateral neck exploration—used for complex conditions to explore all four parathyroid glands to find and remove those that are diseased
- Complex revisional and reoperative parathyroid surgery—for patients who had unsuccessful parathyroid surgery in the past when there is persistent or recurrent hyperparathyroidism
- Mediastinal or ectopic parathyroid surgery—used to treat parathyroid glands located in the chest
- Familial parathyroid surgery—used to treat hereditary forms of hyperparathyroidism, often in children