Is Your Surgeon Cheating During Your Parathyroid Operation?

<% content_for(:page_summary) do %> The internet is full of surgeons who claim to be experts at parathyroid surgery. But are they really doing expert work, or are they cheating and doing a simple operation that any joe-blow surgeon could do? <% end %>

Parathyroid surgery can be very tricky for a number of reasons.  First, there are four parathyroid glands and a person with hyperparathyroidism can have one, two, three, or rarely even four bad parathyroid glands (more details later).  Second, at least thirty percent (30%) of people with hyperparathyroidism will have more than one bad parathyroid gland (two or more parathyroid tumors).  Third, there is no test that can tell a surgeon before the operation which person has only one bad parathyroid gland, and which person has more than one.  Fourth, there is no test that can tell a surgeon during the operation which person has only one bad parathyroid gland and which person has more than one.  Fifth, normal parathyroid glands are only the size of a grain of rice.  Sixth, although parathyroid glands are usually within an inch or two of the thyroid gland, they can be anywhere from under your jaw to down in your chest next to your heart.

Thus, the only way to know for sure if a patient is cured during a parathyroid surgery is for the surgeon to look at all four parathyroid glands and determine if each one is normal (dormant and asleep) or an  overactive parathyroid tumor (adenoma). Anything short of that is cheating or bending the rules with the result that as many as 30% of people will need another operation in the future because all four parathyroid glands were not evaluated.  And to make matters worse, about 1 in 500 people will have five parathyroid glands-and there is no way to tell which person that is! When you combine all these various problems with the fact that some parathyroid tumors are only the size of an almond, and normal glands are only the size of a grain of rice, then parathyroid surgery can be very difficult. This is why all endocrinologists will tell you to get the most experienced parathyroid surgeon you can.

The internet is full of parathyroid surgeons who are cheating their patients.

It is easy to tell who is cheating, and who is not. All you have to do is watch the surgeon's videos and read their websites. Here is a quick rundown of how you can tell the experts from the ones that claim to be an expert but provide no level of expertise over the local surgeon at the hospital down the road.

Here is how you can tell if your parathyroid surgeon may be cheating you:

1. Removing the parathyroid adenoma that shows on the scan and quitting the operation is cheating. If the surgeon says that your scan shows a tumor and he/she is going to make a small incision in your neck and remove the tumor… and nothing else, you may be getting cheated. This operation has a failure rate of 35%.  At least 17% will need another operation within 1 year, and the other 18% will need a second operation within 5-12 years.
2. Performing a different operation if your sestamibi scan (parathyroid scan) is positive vs. negative is cheating. If the surgeon wants to know whether your scan is positive or negative, or sends you for a second scan, then you may be getting cheated. The reason the operation will be different is because the surgeon want's to cheat if the scan is positive and do number 1 above.
3. Operating on one side of the neck and not examining the two parathyroid glands on the other side of the neck is cheating. Although better than simply removing the tumor that shows on a scan and quitting, a surgeon who operates only on one side of the neck saying he/she will look at TWO glands may still be cheating you. The other 2 glands have not been examined and your chance of needing a second operation is at least 15%.
4. Making an incision off to the the side of the neck (instead of in the middle) is cheating. There are some videos online of surgeons claiming to be parathyroid surgery experts and have websites touting their expertise… but their videos clearly show them making an incision off on one side of the neck over top of a parathyroid tumor they see on a scan and removing that tumor and quitting the operation. Those surgeons are the worst, breaking every rule above. These surgeons are cheating and there is no possible way to see all four parathyroid glands from an incision on one side of the neck.
5. Operating only when the scan is positive is cheating. We're going to give these surgeons some slack here, because this is the best thing they can do for you. It doesn't mean you don't need an operation-because you do-it means THEY are not very good at parathyroid surgery and they are telling you this by declining to operate on you. If your surgeon doesn't want to operate on you because your scan is negative, it's because he/she is not confident that they can do the operation. PERFECT-you don't want them as a surgeon anyway!
6. If your surgeon is using words like: "Focused", "Targeted", "Unilateral", "Directed", "Specific", then you have a high chance of being cheated. You can know that he or she has no intention of looking at all four parathyroid glands unless something goes "wrong". These are not the words of an expert. These are the words of a surgeon who is going to do the least amount of operating and hope that you are cured. These are words that experts do not use!
7. If your surgeon says that he/she may have to make the incision bigger so that they can look at the other parathyroid glands, then you have a high chance of being cheated. Clearly their intention is to make a small incision over the hot spot on your sestamibi scan and take that gland out and stop the operation-with or without the bogus PTH assay.
8. Operating without evaluating all four parathyroid glands is cheating.  All five of the cheating methods above are done for one of two reasons, 1) the surgeon does not feel comfortable with his/her ability to find all four parathyroid glands (they lack the skill and they know it!) or 2) the surgeon believes that a cure rate of 90% or less is OK, and believes that he/she can simply operate on you again in the future if you aren't cured. How do we know this with such confidence? Because we used to be one of those surgeons who didn't think it was necessary to evaluate all four parathyroid glands. Up until 2002 we thought that we could tell which patients needed to have all four parathyroid glands evaluated, and which ones only needed 1 or two parathyroid glands evaluated. (see our publication citation at the bottom of this page). We gave up on that one-side operation because it doesn't work. We used to think that we could cure most people with a one-side unilateral operation, and that it was OK to not cure some patients because we could just re-operate on them again on the other side of the neck if they weren't cured. The biggest problem with this is that most doctors can't recognize hyperparathyroidism in the first place, and fewer yet can recognize it after one operation. After operating on tens of thousands of patients with hyperparathyroidism we leaned that people who don't have all four parathyroid glands evaluated don't get cured at least 30-35% of the time. They don't do as well. They aren't as happy. Their bones don't get better. Their kidney stones don't stop. Their depression doesn't go away. Their love-life doesn't improve.  Their fatigue and tiredness doesn't resolve. Their memory doesn't improve. Their energy levels don't get better. Their GERD doesn't go away.  The only way to give parathyroid patients a chance at an improved life is to examine all four parathyroid glands during their FIRST operation. Anything else is cheating, (except in some unusual situations).

Mini-Parathyroid Surgery can be done very quickly, safely, and still LOOK AT ALL FOUR parathyroid glands.

In this video, I perform a four-gland mini parathyroid surgery. It takes less than 13 minutes (it is not a race, but this shows how simple this can be if you have an expert surgeon). There is no blood-it is mostly just my partner Dr Politz talking while I operate. After you watch this, then go online and watch other surgeons perform parathyroid surgery. See if they are examining all four parathyroid glands. See if they make a big deal about the scan (note that this guy has a positive scan for ONE parathyroid tumor but by examining all four parathyroid glands we see that he has TWO parathyroid tumors). See if they make the incision on one side of the neck. See if they quit the operation before all four parathyroid glands are evaluated (they all do). And see if they try to pretend they can tell if the patient is cured by measuring parathyroid hormone (PTH) to see if it has a 50% drop in value (this is the biggest crock of crap ever propagated by surgeons on their unsuspecting patients).

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There is a LOT going on during this operation. To learn more about what we are doing, and what all the technology is that we are using, go to our page http://www.parathyroid.com/parathyroid-surgery.htm that has a narrative about what we are doing. If you understand even half of this page, then you can easily see if your parathyroid surgeon is about to cheat you.

Parathyroid Surgeons Get Paid Too Much To Cheat!

It isn't malpractice for surgeons to cheat, because it isn't malpractice to NOT cure somebody. It isn't malpractice to not cure your breast cancer, but breast cancer surgeons don't cheat and do half an operation.  Nobody cures 100% of hyperparathyroidism; we don't. But parathyroid surgeon cheating is so prevalent now that almost 18% of the 2900 parathyroid operations we do every year are on people who had a surgeon operate on them already. We do about 50 parathyroid operations per week, and at least 8 of them have been operated on before. Almost all of them were never told they weren't cured, and they simply continued to feel bad for several years. They wasted precious years of their life feeling bad because a surgeon cheated them.

Be smart folks. We know everybody can't come to Tampa for their parathyroid surgery, but please be smart and ask tough questions. Don't fall for the slick salesman who is going to operate on your positive scan and then quit. ANY HERNIA/GALLBLADDER/FOOT surgeon can do that. Be smart and take care of yourselves. Demand the best for yourself and your family. Demand answers about how they know you are cured? How do they know that the other parathyroid glands are not tumors also? Ask them how often they take out two parathyroid tumors. Remember, 30% of people with hyperparathyroidism have two or more parathyroid tumors, so if your surgeon says that they take out two tumors in some number less than that, then some of their patients are being cheated.  Make sure your parathyroid surgeon tells you how you will know in 2 months that you are cured. Ask them how often one of their patients is not cured. If they say less than 5%, then get up and walk out.  Parathyroid surgeons get paid too much to cheat!