Condition Overview
Recurrent hyperparathyroidism refers to the recurrence of hyperparathyroidism after initial treatment, usually surgical removal of one or more overactive parathyroid glands or removal of the thyroid. Hyperparathyroidism is a condition where one or more of the parathyroid glands produce excessive parathyroid hormone (PTH), leading to elevated calcium levels in the blood (hypercalcemia). This condition can cause various symptoms and complications, including kidney stones, osteoporosis, fatigue, depression, and abdominal pain.
Recurrent hyperparathyroidism can occur due to incomplete removal of all hyperfunctioning parathyroid tissue, the presence of additional hyperactive parathyroid glands, or the regrowth of previously treated glands. Diagnosis involves monitoring calcium and PTH levels, as well as imaging studies such as ultrasound, sestamibi scan, or CT scan to locate any remaining or new hyperactive parathyroid tissue.
Treatment Options
- Parathyroidectomy
- Description: This surgical procedure involves the removal of hyperactive parathyroid glands. In cases of recurrent hyperparathyroidism, a focused or reoperative parathyroidectomy is performed to target any remaining or regrown hyperactive tissue. This procedure can be challenging due to scar tissue from previous surgeries.
- Indications: Persistent or recurrent hypercalcemia, symptoms of hyperparathyroidism, imaging-confirmed hyperactive parathyroid tissue.
- "Scarless" Parathyroidectomy
- Description: "Scarless" parathyroidectomy, also known as minimally invasive or endoscopic parathyroidectomy, involves removing the hyperactive parathyroid gland(s) through small incisions in the lower lip. This technique aims to reduce visible scarring and recovery time, but is usually not appropriate for patients who already have a scar on their neck.
- Indications: Recurrent hyperparathyroidism, patient preference to avoid a visible scar, suitable candidate for transoral approach.
- Radiofrequency Ablation (RFA)
- Description: RFA is a minimally invasive procedure that uses heat generated by radiofrequency energy to destroy hyperactive parathyroid tissue. This technique is an alternative to surgery for patients who are not candidates for or prefer to avoid surgery. This is rarely utilized for parathyroid problems because the nerve that controls the voice box is usually very close to these parathyroid glands.
- Indications: Patients unfit for surgery, recurrent parathyroid tissue, intrathyroidal parathyroid glands, recurrent hyperparathyroidism with localized hyperfunctioning glands.
Management of recurrent hyperparathyroidism requires a thorough evaluation by a multidisciplinary team, including endocrinologists, surgeons, and radiologists, to ensure accurate diagnosis and effective treatment planning. Early intervention is crucial to manage symptoms and prevent complications associated with elevated calcium levels. Having an experienced team such as that at the Russell Center ensures that you will have access to the widest range of options for your recurrent hyperparathyroidism.
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