Non Surgical Treatment for Hyperparathyroidism I OCC clinic

Hyperparathyroidism(HPT) is an overproduction of parathyroid hormone(PTH). PTH is secreted by the parathyroid glands. We have four parathyroid glands embedded in our thyroid gland, normally they are the size of lentil seed or grain of rice. When they get diseased, they get enlarged and start dumping excess PTH hormone in your blood. The excess hormone affects your bone, kidney as well as other organs.

In the United States, about 100,000 people develop primary hyperparathyroidism disease each year. It is more common in middle-aged women.

Signs and symptoms of hyperparathyroidism

What are the causes of primary hyperparathyroidism disease?

Primary hyperparathyroidism is one of the common endocrine disorders and the majority of the time is benign. It can be caused by:

Adenoma: is a benign tumor of the gland most of the time when one gland is enlarged
Hyperplasia is a condition in which all four parathyroid glands are enlarged.
Cancer: is rare, 90% of patients with parathyroid cancer present with excess parathyroid hormone (PTH)
Parathyroid cysts: fluid sac/collection replacing the parathyroid gland. They can be divided into functioning and nonfunctioning cysts.

How would you know you have primary hyperparathyroidism treatment?

Routine blood workup can show high blood calcium levels. This elevated value can precede the clinical symptoms.
Additional workup for blood PTH levels, Vit D, and 24 urine collection
Bone density scan to look for signs of weak bones
Imaging studies to localize malfunctioning parathyroid glands are:
Sestamibi scan
Neck and Thyroid Ultrasound:
4D Parathyroid CT Scan

Again most of the patients with hyperparathyroidism don’t have any symptoms and their condition is discovered incidentally.

Symptoms can vary depending on the severity and grade of hyperparathyroidism. You may experience fatigue, loss of appetite, depression, mental fogginess, joint pain, and muscle weakness

In advanced cases, the patient can develop nausea, vomiting, confusion, increased thirst, and need to urinate.

If you have any of these symptoms or feel that you are developing parathyroid issues; please consult with your primary care doctor. In some cases, your doctor may refer you to a specialist called an endocrinologist.

What are the complications of primary hyperparathyroidism treatment?

Kidney impairment
Kidney stones
Thinning bones (osteoporosis)
Hypertension

What are your options for primary hyperparathyroidism treatment?

Treatment of overactive parathyroid is based on your physician or specialist recommendation. It all depends on the cause of your elevated calcium or PTH, general health condition and treatment options available :

1- Wait and Watch approach will be recommended if your calcium level is mildly elevated, have normally functioning kidneys, have no history of kidney stones, and have a normal or slightly subnormal bone scan.

If you choose this approach you will need periodic follow-up tests to monitor your calcium levels and bone density.

2- Surgery: is the gold standard and curative treatment for HPT. Parathyroidectomy entails removing only those glands that are enlarged or have a tumor.

3- RFA: is the nonsurgical option for parathyroid patients. It is a promising and effective alternative for managing parathyroid adenomas or cysts, especially in poor surgical candidates.

4- Various Medications can be recommended by your physician or endocrinologist to lessen your symptoms and stop the bone loss. These medications can be used particularly if surgery hasn’t successfully cured the disorder. It can be used if the patient is found to be ineligible or refused either surgery or RFA.

What are the drawbacks of treating hyperparathyroidism disease with surgery?

Complications from surgery are rare and can include: persistent low calcium levels, damage to nerves controlling your vocal cords leading to voice changes /hoarseness, sore throat and postoperative scar adhesions.

Can anyone get hyperparathyroidism treatment without surgery?

There are two minimally invasive procedure which have a role in managing patients HPT :

RFA:

A promising and an effective non surgical alternative for managing parathyroid adenomas, postoperative recurrent adenoma and treating high PTH, especially in patients who are not eligible for parathyroid surgery.
It benefits these patients who need non surgical parathyroid adenoma treatment.

Ethanol ablation/ Sclerotherapy:

Is another non surgical alternative for treating parathyroid cyst. Under ultrasound guidance and using a thin needle; a high grade medical alcohol gets injected into the cyst .
The alcohol induces a chemical ablation causing the cyst wall to collapse and fibrose.

Benefits to choosing radiofrequency ablation for primary hyperparathyroidism treatment over surgery?

Radiofrequency Ablation (RFA) is a very safe procedure with minimal risk. The whole RFA procedure is done through a small puncture into your neck. No postoperative scar or suture following the RFA.

It is an outpatient procedure; typically takes 30-45 minutes depending on the nodule size.

It is performed under local anesthesia so you can avoid all complications related to general anesthesia

No downtime; you can resume your normal activity the day after yours.

Learn more about the treatment of parathyroid without surgery by performing Radiofrequency ablation treatment

About the possible side effects of using radiofrequency ablation for parathyroid treatment

As with any medical procedure, there is some inherited risk however RFA has a very low complication rate and much lower side effects compared to surgery. Some rarely reported risk are:

Temporary hoarseness
Minor skin bruise
Burn at the needle entry site
Minimal bleeding
Nodule rupture
Skin infection
Nodule rupture
Thyrotoxicosis
Hypothyroidism
Fever
Wound infection

How long does it take to recover from radiofrequency ablation treatment of hyperparathyroidism disease?

The RFA procedure is approximately 30-45 minutes long, depending on your nodule size. It is done at our center as an office based procedure under local anesthesia.You can go to work or resume your normal activity the next day.

About our approach to primary hyperparathyroidism treatment

Prior to your RFA you will have a consultation visit with Dr. Elshenawy. She will perform an in-office ultrasound scan of your nodule and review your fine needle biopsy results. Upon her evaluation, she will determine if another FNA prior to RFA is required.

She will explain in detail the RFA procedure, benefits, risks, possible outcomes, and alternative options. A limited blood work panel for thyroid function and blood coagulation factors before the RFA procedure will be required. You will have opportunities to ask questions and address your concerns.

On your RFA procedure day:

In-Office Preoperative Preparation:

You will come to our center to fill out all necessary paperwork.
You will change your clothes into the provided disposable gown. No jewelry, body piercings, or metalware can be worn during the procedure.
The patient is able to breathe and talk during the entirety of the RFA. You will be able to converse with the doctor during the procedure.
Two grounding pads will be attached to the front of your thighs.
Your neck will be cleaned with a skin antiseptic. Then, under sterile conditions, marks will be placed on your skin to demarcate parts of the nodule. The patient’s head will rest on a small cushion and their eyes will be covered with a mask.
Your heart rate, blood pressure, and voice are monitored during the entire RFA.

On your RFA day, you will come to our center to fill all paperwork needed.

You will change your clothes into disposable gowns. No jewelry, body piercing, or metalware can be worn.
The patient is able to breathe and talk the entire time. you will be able to converse with the doctor during the procedure.
Two grounding pads will be attached to the front of your thighs.
Your neck will be cleaned with a skin antiseptic. Then under sterile conditions marks will be placed on your skin to demarcate parts of the nodule. The patient’s head will rest on a small cushion and their eyes will be covered with a mask.
Your heart rate, blood pressure, and voice are monitored during the entire RFA.

RFA Procedure:

First, your doctor will place a local anesthetic under the skin in the front of the neck and surrounding the thyroid gland.
Second, using the same entry hole on the neck, a thin probe will pass into your neck, targeting your thyroid nodule. The RFA will start by ablating the deeper and posterior portion of your nodule. It will then proceed to superficial and anterior portions of your nodule.
A “popping” sound will be heard during the RFA as the tissue is sequentially and successfully being ablated.

In-Office Post RFA Care:

After your ablation, an ice pack will be placed on your neck. You will be monitored for approximately 30 minutes and will then be discharged.
You will be given over the counter medication such as acetaminophen (Tylenol) for inflammation after RFA.

The day after the RFA, your neck will be mildly sore but you will be able to resume all your normal activities. You will be advised to refrain from extra-strenuous activities for 48 hours if possible.

Why OCC thyroid center for your hyperparathyroidism treatment

OCC thyroid center is accredited by the College of American Pathologists(CAP). RFA technique at our center is safe and effective.
Our providers are USA boarded, MD & ECNU certified providers with three doctors who have performed collectively more than 50,000 thyroid/parathyroid interventional procedures including FNA biopsies, ethanol ablation, and RFA.
Our center has been established since 1991 and is considered a national leader in thyroid diagnosis. We have the newest and the highest quality medical equipment.
RFA treatment for your parathyroid disorder is performed by our experienced physicians. We provide a nonsurgical alternative for primary hyperparathyroidism treatment and parathyroid adenoma treatment that’s performed by our experienced providers.
We only ablate and target your lesion so we preserve the remainder of your gland
Our center has a patient’s centered approach and devotion to all our patients, as we know each patient’s condition is unique.
When considering financial cost, RFA procedures at our OCC center are more cost-effective than hospital-based procedures as we have no facility fee charge.

Hyperparathyroidism Treatment Without Surgery