Parathyroid Surgery

ENTRUST Center for Thyroid and Parathyroid Surgery Consist of a multidisciplinary team of experts in the field of Head and Neck surgery, General surgery, Thoracic surgery, Endocrinology, Pathology, Cytopathology, Nuclear Medicine and Interventional Radiology.

All are recognized leaders in the community attempting to coordinate care, providing education, early node and cancer detection. The center offers unmatched surgical expertise, using advanced minimally invasive procedures offering faster recovery, less pain and smaller incision.

BOOK AN APPOINTMENT

STAFF FACULTY

Head and Neck Surgery


General Surgery/ Cardiothoracic Surgeon


Endocrinologist

  • Herbert Rettinger, M.D.


Radiologist


Interventional Radiologist

  • Vascular Interventional Specialist of Orange County - St. Joseph Hospital


Pathologists

  • Orange County Pathology Medical Group


Speech Pathology

  • Dee Parker, Ph.D., CCC-SLP

PROCEDURES PERFORMED

THYROID


Thyroid nodule detection

Thyroid fine needle aspiration biopsy

Endoscopic assisted and minimally invasive thyroid surgery

Partial thyroidectomy

Total thyroidectomy

Completion thyroidectomy

Thyroidectomy for Grave’s disease & Hyperthyroidism

Thyroidectomy for large goiters

Excision of substernal goiters

Mini-sternotomy

Central, mediastinal and later lymph node dissection

Post-operative scan reduction therapy

Radioactive thyroid remnant ablation

Tracheal resection and reconstruction

PARATHYROID


Minimally invasive endoscopic assisted parathyroid surgery

Intra-operative parathyroid hormone assessment

Parathyroid localization scans

Metabolic bone disease consultation for osteoporosis

Parathyroid location

Sestamibi scanning

VOICE & SPEECH


Early voice rehabilitation

Vocal cord medialization surgery

Intra-operative recurrent laryngeal nerve monitoring

THE PARATHYROID

The parathyroid glands are most often found behind the thyroid gland in the neck. The exact locations vary with each person. The parathyroid glands control the level of calcium in the blood. They do this by making parathyroid hormone (PTH). This is a chemical messenger that tells the body how to control calcium.


Understanding The Parathyroid Glands

The parathyroid glands are usually no bigger than grains of rice. Their main job is to keep the level of calcium in the blood within a certain range. Keeping a normal level of calcium helps the muscles and nerves work properly and also keeps bones strong. When there is a problem with the parathyroid glands, the blood calcium level may get too high. This has affects throughout the body.


How These Glands Work

When the blood calcium level is low, the glands make more PTH. This tells the body to increase the amount of calcium in the blood. To increase the blood calcium level, the body may absorb more calcium from food in the intestines; it may also take calcium from the bones. When the blood calcium level is high, the glands make less PTH. This tells the body to decrease the amount of calcium in the blood. To decrease the blood calcium level, calcium is filtered out of the body by the kidneys.


A Problem With The Parathyroid Glands

The parathyroid glands are four tiny glands located in the neck. These glands control the level of calcium in the blood, the most common problem that affects the parathyroid glands is called hyperparathyroidism. This occurs when one or more of the gland is too active, causing a high blood calcium level. Hyperparathyroidism can lead to serious health problems throughout the body, but it can be treated.


When You Have Hyperparathyroidism

With hyperparathyroidism, one or more of the parathyroid glands becomes larger. It then makes too much PTH. As a result, the body continues to increase the level of calcium in the blood. This causes a condition called hypercalcemia (an above-normal level of blood calcium). Hypercalcemia can lead to a number of problems throughout the body. These are listed below.


  • Enlarged parathyroid gland
  • Nervous system problems. A high blood calcium level can make you feel tired, depressed, or irritable. You may also have problems with concentration or memory.
  • Muscle problems. A high blood calcium level can affect the muscles, causing muscle pain and weakness.
  • Kidney problems. As extras calcium passes through the kidneys, you may have frequent urination. And, you’re more likely to develop kidney stones and kidney disease.
  • Digestive problems. The intestines absorb calcium to be used by the body. A high blood calcium level can cause abdominal pain, nausea, vomiting, and constipation. Over time, you may even develop stomach ulcers or pancreatitis.
  • Bone and joint problems. To increase blood calcium, calcium may be taken from the bones. This can cause bone pain and may fractures and bone disease more likely.

  • CAUSES

    What Causes Hyperparathyroidism?


    Hyperparathyroidism most often occurs when one parathyroid gland becomes enlarged, this is almost always because of benign (non-cancerous) growth called an adenoma. In some cases, more than one parathyroid gland becomes enlarged.

  • RISK FACTORS

    Anyone can get hyperparathyroidism. It is more common in women than men. The chance of developing hyperparathyroidism also increases with age. Some factors make the problem more likely, these are known as risk factors. Risk factors for hyperparathyroidism include:


    • Having parents or siblings with hyperparathyroidism
    • Getting too little vitamin d in the diet
    • Having certain kidney problems.
    • Taking certain medications
    • Having had radiation to the head or neck.

  • SYMPTOMS

    Most peoples with hyperparathyroidism don’t know they have it; this is because symptoms of this problem can be very mild or are very similar to those of other health problems, and hyperparathyroidism can cause any of the symptoms below:


    • Muscle weakness
    • Depression

    Hard stools (constipation)

    Stomach ulcers

    Tiredness

    Needing to urinate often

    Poor memory

    Kidney stones

    Nausea and vomiting

    Joint or bone pain

    Pain in the stomach area (or abdomen)

    Bone disease (osteopenia or osteoporosis)

  • EVALUATION

    To learn more about your condition, your doctor will evaluate you. A thorough medical history is taken and you are examined. Some tests may also be done. This evaluation gives your doctor information needed to plan your surgery.

  • MEDICAL HISTORY and PHYSICAL EXAM

    During the medical history, you’ll be asked about your risk factors and symptoms. Be sure to describe any symptoms you have, even if they seem minor. Also mention other medical problems you have or have had in the past. You may be asked about the foods you eat and medications you take. During the physical exam, your doctor will check your head and neck. Other parts of the body may also be examined to rule out other conditions.

  • DIAGNOSTIC TESTS

    Certain tests are done to check for hyperparathyroidism and the risk of related health problems, such as kidney and bone disease. Test may include:


    Blood tests. Samples of blood are drawn from a vein. These are checked for high levels of calcium and PTH. The levels of vitamin D, magnesium, alkaline phosphatase, and phosphorus may also be checked.


    Urine tests. Samples of urine are taken over a 24-hour period. These are checked for high levels of calcium and problems with the kidneys.


    Bone density study. Scans of the hip, lower back, or forearm are taken. This test measures the amount of calcium in the bones to check bone health.


    Imaging Tests. Imaging tests may be done to help the doctor find the parathyroid glands and see which are enlarged. Each test is usually performed by a doctor, or a trained technologist. In some cases, enlarged parathyroid glands can’t be seen on imaging tests.


    A sestamibi scan is used to find any enlarged parathyroid glands. The test can take up to 3 to 4 hours. During the test, a safe radioactive fluid is injected into the veins. This fluid helps make enlarged parathyroid glands show up clearly when a special camera is used.


    An ultrasound can also be used to find enlarged parathyroid glands. Normal glands are to small to be seen, but enlarged parathyroid glands will usually be visible. During this quick test, harmless sound waves are used to form pictures of the parathyroid glands. The pictures are then viewed on a computer screen.


    A CT. (computed tomography) scan combines x-rays and computer processing technology to form pictures. An MRI (magnetic resonance imaging) scan uses magnets and radio waves to form pictures. These tests are done less often, but they can also be used to locate enlarged parathyroid glands.