My Account of Hyperparathyroidism and Parathyroid Surgery Part 3

Peter M. Mowschenson MD  Beth Isreal Deaconess Medical Center, Boston MA
Peter M. Mowschenson MD Beth Isreal Deaconess Medical Center, Boston MA

Choosing the right surgeon to perform parathyroid surgery is very important. The procedure is highly successful when performed by an experienced surgeon.

Dr. Peter Mowshcenson is a surgeon on staff at Beth Israel Deaconess Medical Center in Boston. Thyroid and Parathyroid Surgery are two of his clinical interests, among several others. He has an MD from the University of London Faculty of Medicine. He is also an Assistant Clinical Professor of Surgery at Harvard Medical School.

I was anxious on the day of my appointment with Dr. M. and was a good half hour early. I had a book with me but trying to read while waiting was impossible. The words didn’t make any sense. Much to my surprise, I was called in to see the Dr. after only a few minutes.

I sat down in his leather office chair and was a bundle of nerves. After a brief exchange, he started to go over my forms. Reading what I put for occupation he said, “You’re a writer?”

“Just part time.” I said.

“Aren’t we all?” He chuckled.

He then asked for the name of my primary care Dr. and I told him Dr. Maria Munos. After searching on his computer, he said he couldn’t find her.

“How do you spell it?” he asked.

“M-U-N-O-Z,” I said.

With a twinkle in his eye he playfully said, “You have M-U-N-O-S on your form. “You call yourself at writer?” I found myself laughing with him despite my nerves.

He discussed my test results and the diagnosis of primary hyperparathyroidism. I told him that he operated on my father twice.

“Oh what’s his name?” he asked.

“John Davis.” I said.

“Oh. How’s he doing?” he politely inquired.

“He’s just fine.” I said.

After hundreds of operations, I don’t think Dr. M. remembered my father, however, telling him somehow made me feel better.

After our discussion of my symptoms, test results, and his review of the sestamibi scan, Dr. M. concurred with my endocrinologist’s recommendation for surgery. He did a quick exam of my neck and briefly described the surgery. The operation requires making an incision in the lower neck along the collar line in order to remove the enlarged parathyroid. The incision is usually 3-8 centimeters long.

Dr. M. determined that no further scans or ultrasounds were necessary. The result of the sestamibi scan was enough to proceed. He handed me a four page “note” to help me better understand parathyroid surgery and sent me on my way. I scheduled my surgery for the following month.

Anxiously awaiting surgery. September 2008.
Anxiously awaiting surgery. September 2008.

The Day of Surgery

Dr. M. expects patients to arrive at least an hour early on the day of the operation. We were nearly two hours early. Yes, in addition to dying on the operating table, I was worried about being caught in traffic heading into Boston before dying on the operating table.

I sat with my husband for just over two hours waiting to be called. I admit, the night before I was in tears thinking about my kids, foolishly fearing that I would die during surgery. I was experiencing high anxiety.

To make the experience more interesting, I had a splitting headache which was probably from caffeine withdrawl, as I couldn’t have any that morning. I was not allowed to take aspirin or anti-inflammatory drugs like Motrin 10 days before the surgery. The drugs can interfere with platelet function and increase the amount of bleeding. Needless to say, I felt horrible.

Pre-Surgery. Thinking good thoughts.
Pre-Surgery. Thinking good thoughts.
My neck was marked in pen by Dr. M. The circle indicates the lower left parathyroid to be removed.
My neck was marked in pen by Dr. M. The circle indicates the lower left parathyroid to be removed.

Pre-Op

After waiting just over two hours, a nurse finally called my name. Within minutes I had changed my clothes and crawled into my hospital bed with my head still pounding.

Despite my headache, the BIDMC staff was top-notch, following every pre-surgery procedure with precision. I was interviewed by at least four different medical personnel regarding my surgery, with questions like what medications was I taking, if I had taken any anti-inflammatory drugs, when was the last time I had eaten, and so on.

In accordance with his “note” Dr. M. arrived and marked the incision with a pen. Moments earlier my blood sample was sent for the rapid PTH test in the holding area. I told Dr. M. that I had a splitting headache and asked, “What if I throw up all over the place when I wake up?” To which he replied, “Please don’t.”

My husband having the time of his life while I was under the knife.
My husband having the time of his life while I was under the knife.

The Surgery

Once the anesthesiologist had my IV in place, my husband kissed me, wished me good luck and I was wheeled into the operating room. While I was sound asleep, Dr. M. cleaned the skin with an antiseptic. He used his pen mark as a guide to open the skin, creating flaps above and below the mark to expose the area. He then inspected the area and determined the best approach. He found the enlarged left gland and removed it safely.  The gland was a single fragment of tan-pink soft tissue, measuring 0.8 x 0.6 x 0.3 cm and weighing .24 grams.

Once the gland was removed, a second blood sample was taken to determine the PTH level, before sending me to the recovery room. My levels dropped back to normal immediately. Dr. M. was confident that the hyperparathyroidism had been fixed.

Dr. M. closed the incision very neatly with buried stitches, which are stitches that don’t need to be removed. A dressing was placed over the wound and I was taken to the recovery room.

Just after surgery, feeling nauseous...but alive!
Just after surgery, feeling nauseous...but alive!
Home from surgery. My kids inspecting the incision.
Home from surgery. My kids inspecting the incision.

Recovery

The surgery took about an hour and a half. I was in at 10:55 and out at 12:26. I woke up pretty groggy a little before 1:00. Shortly after waking, I was given 2 - 500 mg tablets of Vicodin. According to the “note” Dr. M. saw me in the recovery room and discussed how everything went, but due to the anethesthia, I didn’t remember that.

I was wheeled to a recovery area where my husband was waiting. The worst part of the recovery was feeling nauseous and exhausted from the anesthesia. The vicodin was very effective, as I didn’t feel much of any incision pain.

Since 1994, BIDMC introduced the same day discharge for patients undergoing parathyroidectomy. It was no surprise that we were discharged as early as 3:30. My instructions were not to take Motrin, ibuprofen or aspirin but I did have a prescription for Vicodin. I was also instructed not to remove the steri-strips, which are the thin paper strips that covered my incision.

The pain from the incision was minimal, the worst being the day of surgery where I would rate it a five on a scale of one to ten. While my voice was fine, some people experience an abnormal (hoarse voice) after the surgery. At times, the enlarged parathyroid gland is very close or attached to the nerve, which controls the voice box or larynx. In order to remove the parathyroid, the nerve has to be gently dissected off the gland, creating the hoarseness. Recovery from this could take a few weeks.

That weekend I took it easy, but remember thinking how well I was feeling. I almost wished for a little more pampering from my family, but I was literally back on my feet the next day.

Two weeks later I saw my endocrinologist, Dr. L. who said my scar looked "pretty". A blood test indicated that the levels of calcuim and PTH were back to normal. I was free to go with no follow up necessary.

Four weeks later I saw Dr. M. It was just a quick visit to examine the incision and see how I was feeling. He also thought I was good to go and that was the last time I was required to see him.

My surgical scar over a year later is hardly noticeable.
My surgical scar over a year later is hardly noticeable.

Nearly Two Years Later

My incision was quite noticeable for several months. It looked like I survived a knife fight! Nearly two years later, it has healed quite nicely and I don’t think much about it.

I was lucky that my symptoms weren’t more severe and that my hyperparathyroidism was recognized at an early stage of the disease – from the routine blood work, required for a routine physical.

I was amazed at how quickly my symptoms vanished after my surgery. My insomnia disappeared within days. I was no longer constantly irritable. Overall, I felt like me again.

Thank you Dr. Mowschenson for your expertise, my surgery was smooth sailing from the day I met you in your office. Thank you for providing all of your patients with the “note”. Without its information, I wouldn't have the surgical details referenced throughout this hub.

This concludes my three part series. If you haven't already, check out part 1 to read from the beginning of my experience with hyperparathyroidism. I discuss the symptoms, causes and treatment. In part 2, read about the various tests I needed when hyperparathyroidism was suspected.

Are you are gearing up for parathyroid surgery? I wish you smooth sailing from start to finish and good luck!


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22 comments

M.E. McDonald 6 years ago

Great articles. Thanks for sharing your story. This has been so helpful to me in my own health journey!


Kristi Maloney profile image

Kristi Maloney 6 years ago Author

Thanks M.E. I am glad you found my story helpful! Good luck to you!


frogyfish profile image

frogyfish 6 years ago from Central United States of America

Good for you - and the doctor...recovery and all of it!

I have recently heard of a procedure that does not require the incision but just does a 'buttonhole' cut. Will have to explore that...it was done in Florida. Thanks again for your story-share and successful recovery!


Donna 6 years ago

I found Part 3! Thanks! This is worth its weight in gold! I am more worried about my terrible insurance and the cost of all of this as opposed to the surgery! Thanks again!


Kristi Maloney profile image

Kristi Maloney 6 years ago Author

Donna,

I am so glad this helped you. Best wishes to you and a speedy recovery. Good luck with your insurance! Don't forget your referrals!


Mark 5 years ago

Was waiting for Part 3....Thank you so much for finishing this excellent story and for the pics too.

I'm having mine done within the next 3 weeks.

Very reassuring...!!!

Thank you!!!!!!!!!!


Barb 5 years ago

Thank you so much for writing about your experience. I am scheduled to have this surgery on Tuesday. I have tertiary hyperparathyroidism, which is what they call it after you've had a kidney transplant and the pt glands are still overactive after having elevated pt hormone due to kidney disease. I am nervous about this and worried about my voice changing or other problems. I am hoping I can go back to work the following week since I have been off for 3 months since the kidney transplant. Thank you again and I hope you are still doing well.


Kristi Maloney profile image

Kristi Maloney 5 years ago Author

Hey Barb,

Thank you for your comment. I am still doing well and I know you will do well also. I was amazed at how smoothly it all went. Best of luck with your surgery and best wishes for a healthy 2011!


Amy 5 years ago

Great recounting of your experience; thanks so much for posting this. I am so glad I found it...I am seeing the endocrine surgeon tomorrow. It always helps to know others who are dealing with the same issues you are.

Is there any way we can see the "note" you referred to?

Thanks again!


Kristi Maloney profile image

Kristi Maloney 5 years ago Author

Hey Amy. Thanks for your comment. I am sorry I don't have the note handy to share, its in storage, but I do appreciate you stopping by and best of luck with your surgery!


ChristineVianello profile image

ChristineVianello 5 years ago from Philadelphia

Thank you for sharing this story.


Kristi Maloney profile image

Kristi Maloney 5 years ago Author

Hey Christine! Your welcome!


Marci 5 years ago

Kristi - thanks for sharing this. I just had surgery on 2/14/11.

I had been feeling "blah" since December 2001, but it wasn't until August 2010 that kidney stones landed me in the ER. I had lithotripsy to break them up, and the follow up physical with my internist that lead to the discovery of my hyperparathyroidism in November 2010. I met with the surgeon in right before Xmas and had surgery scheduled 6 weeks later.

I'm doing quite well three days post surgery - no loss of voice (thank goodness!) but a little neck stiffness. I'm looking forward to getting my energy levels back and making 2011 a great year. Good to see someone else's success story out there.


Deb 5 years ago

I was just diagnosed with hyperparathyroidism as my calcium level was 11.2 and my PTT was 113. I'm to have both a thyroid scan and the sestamibi scan tomorrow to try to ascertain which parathyroid is bad. This series of articles are amazing and I want to thank you for them!


Amy 5 years ago

I posted three months ago and thought I'd post a follow-up. Nothing showed up on my Sestamibi Scan or ultrasound and I thought it might be helpful for others who also have negative scans.

As you mentioned in Part 2, about 40% of adenomas do not show up on the scans. My surgeon, Dr. Duh at UCSF, told me that many patients choose not to have surgery if nothing shows up. He also said that inevitably, they return to have the surgery done. I, however, did not want to wait. I often felt like my thinking was foggy and I hated that. So I chose to have the surgery.

The date was April 7. It took 4-1/2 hours since the surgeon had to look at all four glands. He ended up removing two of them, but only one was affected. It didn't show up on the Sestamibi scan because it was compressed between the thyroid and a piece of tissue. As soon as he lifted the tissue, the gland expanded. The first thing Dr. Duh said to me when I woke up was "You're cured."

I thought I would post my experience in case others reading your account have similar results. I cried after hearing that my scans were negative; I wanted it to be definitive. But life isn't like that and I am relieved that I decided to go ahead with the surgery.


Kristi Maloney profile image

Kristi Maloney 5 years ago Author

Hi Amy,

First of all, congratulations on your successful surgery. You are so brave! You went with your instincts and went ahead with the surgery despite it not showing on the Sestamibi - not an easy decision to make! I am sure you are thrilled that it is behind you! Best wishes for continued good health!!


Mary Beth 5 years ago

Thanks so much for the thorough detailing of your diagnosis and parathyroidectomy. I was diagnosed with hyperparathyroidism around 2002 when I was about 40 and the mother of 2 young children. I had noticed symptoms of memory loss, depression, irritability and difficulty focusing since my early-mid 30's. I realize now many of these symptoms may be a result of elevated calcium levels in my blood due to hyperparathyroidism.

From the beginning my endochrinologists (in TX and MN) have recommended parathyroid surgery. However, I have taken a wait-and-see/monitoring approach even though imaging has shown multiple stones in both kidneys. My bone density scans have been normal. The main reason I have avoided surgery is that I have had negative results on two Sestamibi scans over a period of about 7 years. Therefore, the parathyroidectomy would be exploratory and more complicated as all four (or more) parathyroids would have to be found.

Since I have been reluctant to have surgery, my endocrinologist put me on a 12.5 mg diuretic (hydrochlorothiazide) to help increase urine volumes (I don't have high blood pressure) and help dilute the elevated calcium levels in my urine. I started the diuretic

on July 20th of this year and by August 1, I was starting to see sand/gravel in my urine while vacationing in NJ and Massachusetts. Within the week I had increased pain in my back on the left flank just below the ribs. I went to an ER in Mass. and a spiral CT scan revealed a large kidney stone stuck in the ureter just outside the kidney (1.5 X 1.3 X 1.1 cm). Fortunately, I was able to return home while controlling the pain with ibuprofen and Vicodain. On August 12 I had a ureteroscopy in an attempt to remove the large stone. Unfortunately, this procedure was unable to breakup or remove the blocking stone although a dozen or more smaller stones were recovered. On August 29th I had a second procedure, a percutaneous nephrolithotomy, where a small incision was made in my back and the large stone was extracted. Both procedures required that a urinary stent be put in. I had the second stent removed yesterday. In about a month I will learn the chemical composition of my kidney stones to confirm they are indeed being caused from hyperparathyroidism. Diet can also play a role in stone development.

I am finally ready to find an experienced parathyroid surgeon - perhaps at the Mayo Clinic. My two hospitalizations for the kidney stone procedures (at the Kidney Stone Institute) went very well and I had little to no pain following those. For the benefit of my kids and my future mental health I need to have the surgery while I'm still relatively young. I've read that even 80 year olds are advised to have the surgery in case their memory loss or dementia is caused by their hyperparathyroidism.


Funom Makama 3 profile image

Funom Makama 3 3 years ago from Europe

Nice account, nice to know you are back home and doing well... Thanks a lot for the share


Sparklea profile image

Sparklea 7 months ago from Upstate New York

Kristi: thank you for sharing this vital information, excellent!

I have been doing a song and dance with 2 endocrinologists, who say I am fine, despite a very abnormal bone density, and consistent high calcium levels (last one 10.8); pth 93 (was previously 108 so they said, 'it has come down.), low vitamin D (which they now have me taking 6000 units a day which makes it now normal. Urine creatinine was normal...so I was told, you do NOT have hyperparathyroidism and they sent me back to my primary doctor.

I guess my question is, "If I have normal urine creatinine, but abnormal calcium and and PTH levels - consistently - (back in 2012 my calcium was 10.9) - does this mean I do NOT have hyperparathyroidism?

My primary said, "two endocrinologists have said you are okay". I have told him my symptoms: (have walked every day for years)...hurts my legs and hips to walk, fatigue 'attacks'; feeling of dread when I wake up, sleeplessness, (I was in a public speaking club for 16 years, gave inspirational speeches, taught motivational non credit courses at a college...a very upbeat person); feel like the world is caving in on me, cry easily; sometimes my body throbs in bed at night, to name a few.

I don't know if I should spend the money to see a parathyroid expert which would mean I would have to go out of town.

I have been on the internet for weeks, but then thought of hub pages and wondered if anyone had written about this vital topic.

Thank you so much! Sincerely, Sparklea (SO glad all turned out so well for you and thank you for making your story 3 parts. So much easier to read.


Kristi 7 months ago

Hey Sparklea,

I am sorry that you are going through this. I know it was my elevated calcium and pth levels that was a red flag for my primary care dr. Then the endrocrinolgist concurred and that's when all the tests were scheduled. I think you need to find another endocrinologist. You know your body best. Where are you from? I highly recommend Beth Israel Deaconess Medical Center in MA - BIDMC ranked among the nation's top hospitals in cancer care; the care and treatment of diabetes and endocrinology - this is according to US News and World Report's hospital rankings. Refer to my second article of this series - these are the tests that you should undergo that determined my hyperparathyroidism. I truly appreciate your reading my articles and commenting. It was a pleasant surprise to see your comment on this post. I wish you the best of health!


Sparklea profile image

Sparklea 7 months ago from Upstate New York

Kristi, thank you so much for taking time to respond! Like you, I DO have the elevated calcium and PTH levels. Since both endocrinologists I saw are not paying attention to my symptoms (because my urine creatinine was normal) I said to my primary doctor last week, "CONVINCE ME THAT HAVING A CONSISTENT HIGH CALCIUM LEVEL AND HIGH PTH LEVEL IS NOT DANGEROUS!!!" I see him in a month and he wants me to keep a food journal and he told me he is going to go on the internet and check out what the Primary Thyroid experts are saying, - he said then we will talk about whether or not you should further investigate this.

I will google Beth Israel Deaconess Medical Center in Massachusetts. I live in Upstate New York, so Massachusetts might be doable. I will return to your second article and read it again.

I thank God you took the time to post all this information. Thank you from my heart! Sparklea :)


Sparklea profile image

Sparklea 7 months ago from Upstate New York

Hi Kristi, I googled Beth Israel and we are only 5 hours away - 308.2 miles.

I see my primary in a couple weeks and will see if, in fact, he did check out the parathyroid experts on the internet like he said he would. My big concern is the elevated PTH, Calcium and the abnormal bone density. My lab results for kidneys are normal but never have had them scanned.

Thanks again for all your help. God bless. Sparklea

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