from the Experts at the Norman Parathyroid Center
Interesting stories of hyperparathyroidism we see every day. Parathyroid blog published bi-weekly.
June is 74 years old, and she recently discovered that she has a parathyroid tumor (hyperparathyroidism). The cure is surgery, but that has not been recommended to her. She is being prescribed parathyroid drugs–no, she is being prescribed MORE parathyroid drugs. You see, this tumor is making her depressed, sleepless, osteoporotic, achy and doubled over with GERD (heartburn). She saw her doctor in Tennessee and subsequently filled prescriptions for 4 NEW medications! She’s already on 6 for various problems. She would soon find out that these various other problems are also part of the parathyroid disease.
“You’ve got a lot of complaints,” Dr. Pat-on-the-Back said, “so let’s get to work on them.”
June updated her husband Ozzie on the situation when she got home with a bundle of new bottles of various drugs. Ozzie was less than happy about the expansion of the medicine cabinet, but he was naturally more disappointed that his “June-Bug” was so miserable these days. Unsatisfied by the advice their doctor was giving them about her symptoms, they turned to the internet, found parathyroid.com and read about the symptoms of parathyroid disease. Ozzie is a list-maker. He told June to go get all of her medicine bottles (including the new ones she just brought back from the pharmacy). As they read the list of symptoms, he wrote the medicines she was taking to treat them.
“From where I’m sittin’, you’re taking TEN parathyroid drugs. Why can’t we just take the tumor out and get rid of some of these?” Exactly, Ozzie! He went on. “Let’s see. You’ve been having high blood pressure for the last seven years or so. You’re taking Toprol, Norvasc, and Clonidine. High blood pressure is one of the symptoms of parathyroid disease. Says so right here, June.”
“When your osteoporosis got bad enough, they put you on Fosamax. That was four years ago, right? Anybody that’s keeping count, we’re up to four ‘parathyroid drugs.’ It says here that bone pain is a common symptom of parathyroid disease. Aren’t you taking Vicodin for that?” Ozzie was on a roll!
“Dr. Benny (cardiologist) has you on that blood thinner because of atrial fibrillation–isn’t that what he called it? Six parathyroid drugs. You can’t sleep so you take Ambien every night. You’re depressed, and that’s why you take Paxil. Sign me up, I can diagnose this! You can throw in vitamin D and the purple pill. Your vitamin D is low from this tumor! The GERD is why you take the purple pill. Like I said, that’s 10 parathyroid drugs, June-Bug!”
This is a scenario we see day in and day out. Medical doctors like endocrinologists, well-intentioned as they may be, learned about primary hyperparathyroidism from professors who learned from professors who learned from professors back in the dear old 1930s and 40s. They were taught that because this tumor is considered benign, it need not be removed until it makes the patient very sick. (See related blog on parathyroid cancer) You can just treat the symptoms of the disease with medications waiting for bad things to get “real bad”. Only if things get disastrous enough (i.e. repeated trips to the emergency room for kidney stones, a broken hip from osteoporosis, a calcium level up to stroke levels) would there be a need to do something like have a parathyroid operation to remove the tumor.
Well, we all know that all drugs have side effects. Most of them are expensive as well nowadays. So there is a downside to just watching the high calcium, waiting, and putting patches on symptoms–not the least of which is that the damage that parathyroid disease does to the bones, brain, kidneys, and heart and blood vessels. Over time it will continue this destructive course (See our blog on duration of high calcium). Another frustrating aspect of this treatment strategy is that many of these “parathyroid drugs” don’t work as long as there is a parathyroid tumor present. Leading the list is the bisphosphonate family of medications (ie., Boniva, Fosamax, Actonel, Reclast). These medications are obviously only placating the symptoms but doing nothing for the cause of those symptoms. Worst of all, these patients feel awful.
Back to Ozzie and June … they decided to come and have this curable disease cured, and “clean out their medicine cabinet” as Ozzie put it. They came to Tampa and had the tumor shown in the photograph removed. The procedure took 17 minutes, and her other three parathyroid glands were all normal. She left the hospital about 1.5 hours later to go back to the hotel, and then returned home to Tennessee the next day. She felt no more pain in her wrists and ankles (pain that had plagued her every day for the last 10 years). This was gone within a few hours of surgery. Bone pain is interesting in that way–it seems to immediately resolve once the parathyroid tumor has been removed. Bye-bye Vicodin. We had her discontinue the vitamin D and the Fosamax as well. When we touched base with June 2 months after surgery, she was sleeping restfully each night without Ambien, and she no longer took Paxil for depression. Ozzie jumped on the line, adding, “Doc, we took a hatchet to that list of parathyroid drugs!” She was off the Norvasc, and her cardiologist was working on getting rid of another one of her blood pressure medications.
Parathyroid disease is caused by a tumor. That tumor’s not going to go away and neither are its symptoms. It has to be removed. There is only one known cure for parathyroid disease, and it is surgical removal of the parathyroid tumor. Parathyroid drugs really don’t exist. This disease causes a wide variety of manifestations and symptoms, many of which disappear when the tumor does. As we have said time and again, there is no sense trying to treat parathyroid tumors by giving parathyroid drugs, whether you want to call them drugs for vitamin D deficiency, osteoporosis, insomnia, hypertension, or depression. The message is the same: cure a curable disease and stop the revolving door of medications. Just ask June-Bug!
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Dr. Doug Politz is one of the world's most knowledgeable parathyroid doctors and the second most experienced parathyroid surgeon in the world. Dr. Politz attended LSU Medical School where he graduated with the Chancellor’s Award as the Most Outstanding Graduate. Dr. Politz obtained his surgical training at the University of South Florida in Tampa, working with Dr. Norman for 5 years. Doug is a member of over a dozen surgical societies and is a fellow of the American College of Surgeons (FACS) and the American College of Endocrinology (FACE). He has been awarded the "Patients Choice Award" 8 consecutive years (top 3% of all American doctors), has been named one of America's Top Surgeons annually for over a decade. Dr. Politz has been a senior surgeon at the Norman Parathyroid Center since 2005 and has dedicated his surgical career to the treatment of hyperparathyroidism.