Hyperparathyroidism is a disease that makes people feel bad, causes a number of serious other medical conditions to develop, and can even increase the risk of cancer, heart disease, stroke, and early death. The good news is that this disease is curable, and often curable in less than 20 minutes. The challenge however, is for you to find a surgeon that you are comfortable with, and that is experienced enough in parathyroid surgery so you can be cured of the problem without enduring some of the very unpleasant complications known to be associated with parathyroid surgery. No matter what you read or what doctor you talk to, they will all agree that parathyroid surgery can be quite tricky and therefore surgeon experience is very important. The potential complications from this operation can be devastating, which is why there are experts who specialize in this operation. In the hands of experts this operation can be an extremely simple outpatient procedure for almost every patient.
Choosing a surgeon is an important decision. You should ask him/her of their training in parathyroid surgery. You should ask them how many parathyroid operations they perform every week. They should be able to show you their operation schedule and hopefully you will not be the only parathyroid operation on the schedule. Hundreds of scientific studies over the years, in every country, show that the cure rate and the complication rate for parathyroid surgery is dependent upon the experience of the surgeon. Surgeons who perform less than 50 parathyroid operations per year typically have worse results, and those performing less than 25 have even worse results. Be careful of surgeons who discuss thyroid surgery rather than parathyroid surgery—they are not the same and a surgeon who performs thyroid surgery weekly is not necessarily experienced and expert in parathyroid surgery (the decision making process in the operating room is very different).
You should ask about the possibility of vocal cord injury, and this should be much less than 1%. Some surgeons will monitor your vocal cord nerve during an operation, however this technique does not decrease the incidence of vocal cord injury and may actually increase your risk. Some experts perform this operation without endotracheal anesthesia (a tube is not put into the trachea for breathing purposes), but again, this is surgeon preference and often a choice due to the experience of the surgeon and anesthesia team. These are important items to discuss. Surgeons with lots of experience will rarely keep a patient in the hospital overnight for monitoring, thus discussing how long you will be in the hospital will give you an idea of your surgeon’s level of expertise and confidence. A quick and successful operation should allow most patients to go home within 2.5 hours of the operation.
Watch your surgeon’s reaction to your scans. Surgeons with less experience almost always rely on scans more than surgeons with extensive experience. Surgeons who order multiple scans are typically less experienced. If your scan is negative and the surgeon decides to “monitor” you for a while rather than operating, he/she is telling you that they are not confident that you will have a good outcome. This does not mean that you should not have the operation; it simply means that particular surgeon is not comfortable operating without a positive scan. These are typically less experienced surgeons. This is a time to find a more experienced surgeon, this is not a time to “do nothing” for a while and get another scan in 6 months.
You should talk to your surgeon about how he/she will determine if all of the parathyroid tumors have been removed prior to concluding your operation. The highest cure rates are seen when an expert parathyroid surgery examines and evaluates all four parathyroid glands during the operation. The lowest cure rates are typically seen with surgeons who remove one parathyroid gland, do not check the other parathyroid glands, and rely on a PTH test to determine if you are cured.
Spending the night in the hospital “to monitor” your calcium levels is not routinely necessary. This is another item you need to talk about, understanding that less experienced surgeons tend to keep their patients in the hospital longer, and even over night. However, remember that safety is always the most important factor so if your surgeon feels more comfortable doing this, then let him/her. Ask about what kind of sutures will be used to close your skin. Experts rarely use any type of suture that requires you to return to the office to have the stitches removed. Avoid a surgeon who uses staples on your skin.
In summary, be confident in your surgeon. Don’t be afraid of asking to see a different surgeon—this is your decision to make. Make sure you are comfortable with how he/she answers your questions. Be smart and take your time making this important decision. Do not feel rushed. Hyperparathyroidism is a disease that damages our bodies over years, so taking a few weeks or even a month or two to make this important decision is fine. Be happy with your surgeon and then relax and look forward to feeling better and a healthier body!