Introduction to the Parathyroid Section
Josef E. Fischer MD
The world of surgery for hyperparathyroidism is in transition, and it is not difficult to understand why this is the case. Hyperparathyroidism is a protean disease with symptoms that are sometimes difficult to decipher. It is not a rare disease—incidence ranges between 1 to 1,000 of the population to 1 to 2,500 of population—and it is also a disease of the elderly that disturbs homeostasis to the extent that it interferes with quality of life. Furthermore, because the number of elderly is increasing, and any operation that requires general anesthesia in the elderly is fraught with hazard, not only for the operation itself but in their ultimate recovery of their mental faculties, one can easily understand the great interest in operations that can be carried out quickly, efficiently, and without full-dress exploration of all four parathyroid glands, which remains the gold standard, with the highest cure rate of 99% to 100%, provided it is carried out in the hands of an experienced parathyroid surgeon. Two of the large-series experienced parathyroid surgeons quoted in this section are Dr. Jonathan van Heerden, and his group at the Mayo Clinic in Rochester, and Dr. Orlo Clark of the University of California in San Francisco. Both agree that in the hands of an experienced parathyroid surgeon with adequate workup and a diagnostic array, which is not terribly complicated and agreed on by most, that the positive outcome of relief of hypercalcemia and hyperparathyroidism should be in the range of 99% to 100%. Much of this is made possible by newer imaging techniques, including the Sestamibi scan and real-time ultrasound.