The Parathyroid Forum

[Mary]

I am very thankful that my surgeon checked all 4 glands. I ended up having two tumors. The surgeon took biopsies of all four parathyroids and my thyroid. The scar is small and in the crease of my neck. The PTH level went from 61 to 11 after the second gland was removed.

[Wilson]

Hate to be overly cynical, but isnt dr norman increasing his marketing advantage now that one gland focussed minimimally invasive ops are two a penny?

[kathy]

In hindsight, I wish my surgeon would have checked all 4. Whether the 2nd tumor was there or not in January 2011, we will never know. But my PTH only dropped to 50 during my 1st surgery.

The 2nd tumor was certainly there by fall, 2011, though, because my symptoms kept getting worse.

All is good now.. no harm, no foul. I'm just glad it is gone! My PTH dropped to 11 or 12 during this surgery.

[john b]

The chance of having one Parathyroid gland being a loose cannon is slight, but that two would be not working right would be vary rare; unless there is some condition that connects all the glands together. Well - that's my way of thinking.

John B

[Admin]

Hi John,

True, Primary Hyperparathyroidism in itself is relatively rare 1 in 1,000 per head of population, yet the incidence of more than one tumour in that population is about 4 - 6%. The problem lies in the fact that in those 4 - 6% with more than one tumour - the radioactivity of the sestamibi tends to pool in the larger tumour and the smaller tumour does not 'show up'. Patients with more than one tumour often feel some benefit from having the larger one removed, but as the smaller one grows, they end up ill again. The focused surgery works for most, but not those unfortunate 4 - 6 %. In the practice of a skilled and experienced surgeon such as Dr. Norman, there is little difference in incision size, operating time, recovery and complications between 'focused' and a full exploration of all 4 glands, and so it makes sense for both surgeon and patient to have all 4 glands inspected whilst under the knife.
I would argue that the decision to go focused or full exploration would be a different matter if you were seeing an inexperienced surgeon who's focused surgery is something like a 2-3 inch scar and whose 'full exploration' is a 5 - 6inch scar with a week in hospital to recover. In that case I would probably go for the focused surgery and 'hope' I wasn't one of the unlucky 4 - 6 % who had more than one tumour. There are unfortunately, plenty of local NHS surgeons out there who do a 5 - 6 inch scar for a full exploration. This is one of the reasons I looked outside of my local PCT for parathyroid surgery.

Simon

[Stef]

Hi,
I'm looking for an experienced doctor/surgeon to be referred to in case (and it seems likely) I need an operation. The consultant at my local hospital is sending me on to the endocrinology department after blood tests revealed high calcium and parathyroid hormone levels and low Vitamin D. I would rather consult with an expert at all stages and am trying to find an NHS hospital + surgeon I can get to. I live in the south east of the UK. How can I find out if the doctor has done at least 50 such operations without insulting him/her? I do not want the sort of mess that happened to a relative of mine when she went to her local hospital. Any suggestions?

[Admin]

Hello Stef,

Welcome to the forum, I hope you find it useful.

I have a list of UK Endocrine Surgeons who are as far as I can ascertain members of British Association of Endocrine and Thyroid Surgeons (BAETS). Not all surgeons who are members of British Association of Endocrine and Thyroid Surgeons have 50+ parathyroid surgeries under their belt. I have tried to keep my list to those who claim to have a particular interest in parathyroid surgery. You will of course have to check exactly who has done how many surgeries. I'm not even sure of my own surgeons (Mr. Andrew McLaren) rate per year, but I know he does more than enough to be very proficient at it as he cured me with a very small (5cm) scar to check all 4 glands visually. Being based in the SE, you have two London based surgeons to go at with 'nearby' Oxford and Wycombe. I had to travel from Sheffield to Wycombe, but it was well worth it knowing I was in safe hands.
One or two of the London hospitals have good medical endocrinology depts. along with competent surgeons attached.
Hope this helps.

Simon