WHEN PARATHYROID GLANDS MALFUNCTION

Tiny glands can cause a host of big health problems that TGH parathyroid gland surgeons excel at treating

BY KAREN FELDMAN

Two pairs of rice-sized glands pack a big punch when it comes to keeping our bodies in good working order.

Most people haven’t even heard of parathyroid glands, but these four tiny organs tucked behind the thyroid gland in our necks produce a hormone that regulates calcium in the blood. When they malfunction, calcium blood levels become unbalanced, causing a wide range of unwelcome symptoms, such as chronic fatigue, insomnia, memory loss, kidney stones, cardiac arrhythmias, chronic kidney disease, and osteoporosis.

The good news is that this condition, referred to as hyperparathyroidism, is most often caused by a benign tumor in the glands. The tumor—or the gland in which it is situated—can be surgically removed in a simple outpatient procedure, solving the problem. (A less common condition, known

Dr. Doug Politz and Dr. Jose Lopez perform parathyroid surgery.

IT’S A CURABLE DISEASE. NOT MANY SURGEONS GET MUCH EXPERIENCE TREATING IT. IF YOU GET A LOT OF EXPERIENCE WITH THIS ONE RELATIVELY UNCOMMON ORGAN, YOU ARE ON TRACK TO BECOME AN EXPERT AT IT.” —Dr. Doug Politz

as secondary hyperthyroidism, is caused by deficiencies of calcium or vitamin D in the diet or, in some cases, chronic kidney failure.)

Tampa General Hospital’s Parathyroid & Thyroid Institute has the distinction of performing more parathyroid operations than any other hospital in the world over the past decade. The institute is led by two surgeons who have devoted their lives to diagnosing and treating this condition.

Meet the Experts

Dr. Doug Politz and Dr. Jose Lopez are general surgeons who have focused their practices on treating patients with parathyroid problems. “Patients get tumors that are almost never cancerous but do cause a lot of harm,” Politz said. “We’ve seen just about everything this disease can throw at you.” Politz developed an interest in parathyroid conditions when he did a rotation in the endocrine surgical department as a surgical resident. “I took to it very quickly,” he said. “It’s a curable disease. Not many surgeons get much experience treating it. If you get a lot of experience with this one relatively uncommon organ, you are on track to become an expert at it. That did appeal to me.”

He added: “Waiting rooms are filled with patients with diseases you can’t cure—diabetes, heart disease, asthma. With this, you can cure the patient. To me, that’s very appealing.”

And now, having examined some 25,000 glands and performed over 8,000 parathyroidectomies, he is that expert who can remove even the tiniest of tumors or the miniscule organs altogether, providing a cure for the patient.

Lopez was performing colorectal surgery at TGH and was considering going into private practice when a vacancy opened for a surgeon to treat parathyroid disease. “If I concentrate on one organ, I bet I’d be really good,” he reasoned. “I really enjoy the operations and how challenging they are. I’m still learning despite doing thousands and thousands. People will travel to see us, and that makes us feel very proud of what we’re doing here. There’s not a single day when I leave the hospital when I don’t feel proud of what I did in the operating room.”

Lopez and Politz are great friends and colleagues, winning praise from patients and accolades such as “Compassionate Doctor,” “Patient’s Choice,” and “On-Time Physician” awards. Best of all, they love what they do and working together.

“Surgery is really the only treatment for this,” Politz said. “The nice thing is it is a pretty quick procedure. You make a small incision in the neck. Locate the glands, find the tumors, confir the number—70 to 75 percent of the time it’s just one tumor, although there can be two or three or four—and remove them.”

Symptoms and Treatment

How can you tell if you have parathyroid disease? Politz recommends keeping an eye on the calcium levels in your routine blood tests, particularly if you are older than 35. If the level is above 10, there’s cause for concern and it may be time to consult a specialist. It is a well-known cause of osteoporosis and kidney stones. “What most people complain of are the other problems—neurocognitive problems,” Politz explained. “They are tired, depressed, and achy. They can’t sleep, can’t concentrate, can’t remember things. Only 20 to 25 percent ever get a kidney stone. Fewer get osteoporosis, but they describe themselves as meaner and nastier and say, ‘I’m tired all the time.’ ”

In addition to assessing the state of the parathyroid glands, the surgeons routinely examine their patients’ thyroid at the same time. In about 25 percent of the cases, Lopez said, they may have a thyroid tumor as well. If that’s the case, the physicians discuss treating the thyroid at the same time as the parathyroid glands.

In some cases, the parathyroid glands can be located inside the thyroid, making it necessary to remove a portion of the thyroid to get to the parathyroid tumors. The good news is that only a portion of one gland is required to produce the hormone needed to regulate calcium in the blood, Politz said.

So why do we have four—or in rare cases, five—parathyroid glands? Think of them as a security system.

Dr. Doug Politz Dr. Jose Lopez

SYMPTOMS OF PARATHYROID GLAND MALFUNCTION FATIGUE MEMORY LOSS BODY ACHES INABILITY TO CONCENTRATE BONE PAIN DIFFICULTY SLEEPING DECREASED LIBIDO (MORE COMMON IN WOMEN) HEART PALPITATIONS HIGH BLOOD PRESSURE EXCESSIVE URINATION KIDNEY STONES NAUSEA CONSTIPATION LOSS OF APPETITE

“We have two kidneys, two lungs, in case one goes bad,” Lopez said. “The body needs very tight calcium control. It doesn’t like a fluctuatin level. The more thermostats, the more sensors, the faster the thermostat can adjust. When four are working, the first one senses the calcium is low.”

Calcium plays a crucial role as a facilitator of communication among cells. “Muscles contract because of calcium,” Lopez said. “Nerves communicate because of calcium. So, calcium is being constantly monitored. High calcium is bad. Low calcium is bad. That’s why there are four parathyroid glands making sure the calcium is at a good range.”

Among the unique features of the Parathyroid & Thyroid Institute is that patients do not require imaging studies prior to surgery. On the day of surgery, each patient receives a sestamibi scan, in which a small dose of a radioactive compound is administered intravenously. It adheres to the parathyroid gland, allowing the surgeons to detect any growths. A thyroid ultrasound is also conducted to evaluate the thyroid for suspicious nodules. These procedures result in precise diagnoses and reduce the number of visits and tests most patients must undergo before surgery to remove the growth and the problem.

It’s a practice that gives Politz and Lopez great satisfaction. “The best part of my day is knowing that I’ve been able to do something every day that our patients are going to benefit from,” Politz said. “They are going to walk away and be better than when they arrived.”

Tampa General Hospital Parathyroid & Thyroid Institute Phone: 813-844-8335 Website: tgh.org/parathyroid