• Parathyroid Surgery

    The Sure and Simple Cure

Parathyroid Surgery with Dr. John S. Kennedy

The Sure and Simple Cure

Although untreated hyperparathyroidism can cause very serious and even life-threatening health problems, the good news is that we have a highly effective cure. Parathyroid surgery removes the overactive parathyroid gland. The remaining healthy glands then return your calcium levels to a healthy normal.

With our minimally invasive surgical techniques, recovery from surgery is quick and easy. The procedure is effective 98% of the time, and your calcium levels will drop to normal  within a few days. Any symptoms you’ve experienced should soon fade away.

If you are interested in becoming a patient, please contact us.

Minimally Invasive Surgery: A Tiny Cut for a Quick Cure
What to Expect: The Day of Your Cure
Post-Op Care: Be Good to Your Body
Calcium Corrected: Life With Healthy Parathyroids

Minimally Invasive Surgery: A Tiny Cut for a Quick Cure

Until the early 1990s, parathyroid surgery required a long incision across the neck: a “Frankenstein” cut, as some patients came to know it. The procedure would take several hours and required a hospital stay.

Today, we have a much less invasive approach: minimally invasive radioguided parathyroidectomy, or MIRP. With MIRP, we operate through a much smaller incision, about one inch long. The operation takes about 30-60 minutes, and you can go home the same day.

Despite the small incision, we test all four of your parathyroid glands during the operation. In most cases, the sestamibi scan and ultrasound will already have identified the most overactive gland, but we check the remaining glands too. If additional glands are overactive, we remove them during the same operation. This is why the success rate for the operation is so very high.

Guilty Until Proven Innocent

Most often, hyperparathyroidism is caused by a single overactive parathyroid gland. Preoperative ultrasound and sestamibi scans usually give us a pretty good idea of which parathyroid gland is the most overactive. If we simply remove that gland and do nothing else, the success rate for curing hyperparathyroidism is about 90%.

We don’t think that’s good enough, so, during surgery, Dr. Kennedy investigates your other three parathyroid glands. Specifically, he takes a tiny biopsy of each gland and tests it immediately for the presence of that radioisotope we gave you for your sestamibi scan. That’s why we give you the sestamibi scan right before surgery. The radioisotope is very short-lived and will soon be gone from your body.

If any additional glands show a high count of the radioisotope, we know they’re guilty too. Dr. Kennedy can then remove them during the same surgery. With this additional testing, our success rate is about 97%. And yes, we’re always looking for ways to get to 100%.

If you are interested in becoming a patient, please contact us.

“I consider all four parathyroid glands guilty until proven innocent. During surgery, I take each one in for questioning, then release them if they look OK.”

Dr. John S. Kennedy

What to Expect: The Day of Your Cure

When you wake up on the morning of your parathyroid surgery, you can look forward to going to sleep that night in your own bed and with your hyperparathyroidism cured. In between, you’ll have a quick procedure to remove your overactive parathyroid.

The first step will be your sestamibi scan. We’ll give you a tiny dose of the radioisotope intravenously, helping us pinpoint the location of your problem parathyroid. The radioisotope is short-lived, but it will still be active during the operation, guiding us as we go.

Although parathyroid surgery can be done under local anesthetic, this can be a little uncomfortable and we don’t recommend it. Usually, we’ll instead use a light general anesthetic. You can take a short, pain-free nap while we get to work locating and removing your overactive parathyroid.

The surgery takes about 45 minutes to an hour. Removing the problem parathyroid actually takes considerably less time than that. However, you may have more than one overactive gland. That’s why we take extra time during the operation to examine your other three parathyroids. This makes it much less likely that you’ll need a second surgery and more likely that you’ll be cured. How likely? About 98%.

When we’re done, we’ll bandage the little incision (no stitches to remove) and wake you up. You may feel a little sore and your voice may be slightly hoarse from the anesthesia.

An hour or two later, you’ll be up and on your way.

“Hyperparathyroidism has lots of symptoms, and there are lots of benefits to surgery. Once I remove the overactive parathyroid, it immediately solves the problem.”

Dr. John S. Kennedy

Post-Op Care: Be Good to Your Body

Though minimally invasive parathyroid surgery is far gentler on your body than the older alternatives, you should still take it easy while you recuperate fully. The anesthesia used during surgery may leave you feeling sleepy for up to 24 hours.

You may not have much of an appetite for the first day or two, so stock up on easy-to-digest foods such as bananas, breads, soups, and juices. You should also plan on eating plenty of foods rich in calcium and vitamin D, such as leafy greens and dairy products. When your overactive parathyroid is removed, it can take a little time for your remaining parathyroids to restore a healthy calcium level to your blood. Supplements and calcium-rich foods will make sure your body has enough calcium to work with.

Plan on taking a few days off of work, or longer if your job involves heavy lifting or lots of standing and walking. Also stay out of the driver’s seat until you can turn your neck fully without pain, so you’ll be a safe driver behind the wheel.

You’ll have some mild discomfort at the incision for a few days. You can manage this with over-the-counter non-aspirin pain relievers or prescription pain medication. Because the incision is so small, the discomfort should fade away quickly. You’ll be back to your normal routine in no time, with all the health benefits of a healthy calcium level in your blood.

Skin Care

Minimally invasive parathyroid surgery will save you from the “Frankenstein” incision lines of traditional parathyroid surgery. Though much smaller, your incision will be noticeable for a few months. To help speed healing, use silicone sheet dressings and vitamin E cream. Also massage the area daily for several minutes to break up any scar tissue.

Follow-Up Exam

If you live in the Atlanta area, we’ll ask you to come in for a follow-up exam with Dr. Kennedy one to two weeks after your surgery. We’ll test your PTH level to verify your cure and make sure your incision is healing well. You should also get a calcium level test, usually 3-6 months after your surgery.

If you travel to us for the surgery from out of town, we can instead coordinate with your local primary care physician or endocrinologist. The follow-up exam is straightforward, but we do want to make certain that you’re cured and healing well.

Calcium Corrected: Life With Healthy Parathyroids

97% of the time, you will be cured of hyperparathyroidism as soon as you wake up from surgery. The level of parathyroid hormone (PTH) in your blood will drop almost immediately.

It may take a day or two for the calcium level in your blood to return to a healthy balance. You may actually have slightly low calcium levels until your remaining parathyroid glands rev up to take over from the overactive gland we have removed. (This is why you will probably be advised to take calcium and vitamin D supplements during your recovery.)

Other symptoms caused by hyperparathyroidism should also soon improve, each on their own timeline. Muscular weakness and bone pain should go away very quickly. Acid reflux, if caused by high calcium, should improve in a day or two. During the first week or two, you should see improvements in memory and concentration, headaches, and irritability. Depression caused by hyperparathyroidism may take a month or two to improve.

Every person is unique. Your recovery will follow its own timeline. You may have more or less relief, depending on any other underlying health issues you have. But most patients notice swift and dramatic improvements after parathyroid surgery. We’re confident you will too.

Frequently Asked Questions

How many parathyroid operations do you perform EACH WEEK?

Dr Kennedy performs parathyroid operations virtually every week, anywhere from 2 to 6.

Will I have general anesthesia?

Dr. Kennedy collaborates with the anesthesia team in order to provide the safest anesthesia possible for each patient.  This is most often a short general anesthesia. Side effects are possible but unlikely.

Will I have to spend the night in the hospital after the operation?

Virtually all patients are outpatients, going home or back to their hotel for out of town patients, the same day

What probe do you use a probe to help find the bad parathyroid gland?

A gamma probe that is made for use in parathyroid surgery is used to measure the radioactivity of each gland, to help determine whether it is overactive or normal (dormant).

Do you remove a gland and then measure the PTH level to see if the gland you removed was bad?

Dr. Kennedy uses the probe to measure the activity of each gland individually, just as Dr. Norman’s group does. He does not need to measure the blood PTH level during the surgery in routine cases.

Will you be putting a drain in my neck?

Dr. Kennedy does not use drains.

How big will the incision be?

The incision is usually about one inch in length, could be longer in overweight patients.

If you don’t find the tumor easily, will you need to make the incision larger?

The incision is only made as long as needed, and usually only about 1 inch.

Will there be stitches or staples to take out?

All stitches are absorbable and hidden under the skin.  You will be able to shower from day one.

Will you put a breathing tube in my throat to monitor my vocal cords during surgery?

Dr. Kennedy does not use vocal cord nerve monitoring.  He has never had a patient develop permanent hoarseness due to a vocal cord nerve injury.

What is the chance that you could damage my vocal cord nerve?

The chance is exceedingly rare, close to 0%.  Some patients may be hoarse for a day or two.

Do you remove a gland and then measure the PTH level to see if the gland you removed was bad?

Dr. Kennedy checks all four glands, and removes any abnormal glands, leaving the normal glands.  When this is done, there is very little to be gained from checking the blood PTH level during the surgery, so this is not done routinely.  Dr. Kennedy will check the PTH level in the recovery room, in order to document the appropriate drop following a successful operation.

What is the charge for reviewing my health records?

The review of patient records is included in the consult fee; there is no additional charge.