One-side parathyroid surgery has poorer long-term outcomes

Dr James Norman, MD and his partners at the Norman Parathyroid Center have published a landmark study in this week's Journal of the American College of Surgeons describing how the operation they developed and advocated for more than 19 years has significantly poorer long-term outcomes. The unilateral or "one-side" parathyroid surgical procedure to remove parathyroid tumors from patients suffering from hyperparathyroidism is a dramatic change from the large neck operation that it replaced. Dr Norman and his partners have published many articles touting the benefits of the smaller, one-side operation, a procedure that has become the standard operation world-wide. Long-term followup, however, shows that many patients having a one-side operation will need another operation some years later to remove a second tumor.

"We changed parathyroid surgery forever in the mid 1990's by developing and advocating the use of technology to allow one-side neck operations to remove parathyroid tumors," said Norman. "We have performed over 17,500 parathyroid operations and unfortunately, quite a few patients who we believed were cured after a one-side operation began showing up with another parathyroid tumor between 3 and 15 years later. They obviously had a second smaller tumor that we did not see. In contrast, those patients in whom we examined all four parathyroid glands had a second tumor removed 20% of the time and their long-term cure rates remain near 100%."

"We began noticing big differences in cure rates about 6 years ago and thus began our avoidance of one-side parathyroid surgery," stated Dr Douglas Politz, a co-author. "Fortunately for the patients, the new mini-parathyroid operation to look at all 4 glands (both sides) is actually smaller and faster than the one-side operation we developed 18 years ago using techniques we are teaching with videos online."

"This is a very significant change in surgical practice," stated Dr Lee Metchick, an endocrinologist in Central Florida. "If one parathyroid tumor is removed and a smaller, second tumor remains, the patient doesn't achieve the full benefits of the operation."