from the Experts at the Norman Parathyroid Center
Interesting stories of hyperparathyroidism we see every day. Parathyroid blog published bi-weekly.
Parathyroid surgery can be very tricky for a number of reasons. First, there are four parathyroid glands and a person with hyperparathyroidism can have one, two, three, or rarely even four bad parathyroid glands (more details later). Second, at least thirty percent (30%) of people with hyperparathyroidism will have more than one bad parathyroid gland (two or more parathyroid tumors). Third, there is no test that can tell a surgeon before the operation which person has only one bad parathyroid gland, and which person has more than one. Fourth, there is no test that can tell a surgeon during the operation which person has only one bad parathyroid gland and which person has more than one. Fifth, normal parathyroid glands are only the size of a grain of rice. Sixth, although parathyroid glands are usually within an inch or two of the thyroid gland, they can be anywhere from under your jaw to down in your chest next to your heart.
Thus, the only way to know for sure if a patient is cured during a parathyroid surgery is for the surgeon to look at all four parathyroid glands and determine if each one is normal (dormant and asleep) or an overactive parathyroid tumor (adenoma). Anything short of that is cheating or bending the rules with the result that as many as 30% of people will need another operation in the future because all four parathyroid glands were not evaluated. And to make matters worse, about 1 in 500 people will have five parathyroid glands–and there is no way to tell which person that is! When you combine all these various problems with the fact that some parathyroid tumors are only the size of an almond, and normal glands are only the size of a grain of rice, then parathyroid surgery can be very difficult. This is why all endocrinologists will tell you to get the most experienced parathyroid surgeon you can.
It is easy to tell who is cheating, and who is not. All you have to do is watch the surgeon’s videos and read their websites. Here is a quick rundown of how you can tell the experts from the ones that claim to be an expert but provide no level of expertise over the local surgeon at the hospital down the road.
In this video, I perform a four-gland mini parathyroid surgery. It takes less than 13 minutes (it is not a race, but this shows how simple this can be if you have an expert surgeon). There is no blood–it is mostly just my partner Dr Politz talking while I operate. After you watch this, then go online and watch other surgeons perform parathyroid surgery. See if they are examining all four parathyroid glands. See if they make a big deal about the scan (note that this guy has a positive scan for ONE parathyroid tumor but by examining all four parathyroid glands we see that he has TWO parathyroid tumors). See if they make the incision on one side of the neck. See if they quit the operation before all four parathyroid glands are evaluated (they all do). And see if they try to pretend they can tell if the patient is cured by measuring parathyroid hormone (PTH) to see if it has a 50% drop in value (this is the biggest crock of crap ever propagated by surgeons on their unsuspecting patients).
There is a LOT going on during this operation. To learn more about what we are doing, and what all the technology is that we are using, go to our page http://www.parathyroid.com/parathyroid-surgery.htm that has a narrative about what we are doing. If you understand even half of this page, then you can easily see if your parathyroid surgeon is about to cheat you.
It isn’t malpractice for surgeons to cheat, because it isn’t malpractice to NOT cure somebody. It isn’t malpractice to not cure your breast cancer, but breast cancer surgeons don’t cheat and do half an operation. Nobody cures 100% of hyperparathyroidism; we don’t. But parathyroid surgeon cheating is so prevalent now that almost 18% of the 2900 parathyroid operations we do every year are on people who had a surgeon operate on them already. We do about 50 parathyroid operations per week, and at least 8 of them have been operated on before. Almost all of them were never told they weren’t cured, and they simply continued to feel bad for several years. They wasted precious years of their life feeling bad because a surgeon cheated them.
Be smart folks. We know everybody can’t come to Tampa for their parathyroid surgery, but please be smart and ask tough questions. Don’t fall for the slick salesman who is going to operate on your positive scan and then quit. ANY HERNIA/GALLBLADDER/FOOT surgeon can do that. Be smart and take care of yourselves. Demand the best for yourself and your family. Demand answers about how they know you are cured? How do they know that the other parathyroid glands are not tumors also? Ask them how often they take out two parathyroid tumors. Remember, 30% of people with hyperparathyroidism have two or more parathyroid tumors, so if your surgeon says that they take out two tumors in some number less than that, then some of their patients are being cheated. Make sure your parathyroid surgeon tells you how you will know in 2 months that you are cured. Ask them how often one of their patients is not cured. If they say less than 5%, then get up and walk out. Parathyroid surgeons get paid too much to cheat!
James (Jim) Norman, MD, FACS, FACE, is recognized as one of the world's foremost expert on parathyroid disease and hyperparathyroidism and has treated far more parathyroid patients than any other doctor in the world. He is the founder of the Norman Parathyroid Center in Tampa, Florida, the world's leading center for the diagnosis and treatment of hyperparathyroidism. Dr Norman has made numerous contributions to to the understanding of parathyroid disease and is credited with dramatically changing the way parathyroid surgery is performed. He is a fellow of the American College of Surgeons (FACS) and also a Fellow of the American College of Endocrinology (FACE). He is recognized in the top 1% of all surgeons by US News and World Reports in addition to dozens of other awards and Best Surgeon accolades. He has published over 250 peer-reviewed journal articles. Dr Norman and his partners perform more than 3,300 parathyroid operations annually on patients from all over the world.