Parathyroid gland surgery in Bangalore Indiac & Cost (Parathyroid surgery)


 Endocrine Surgeon In Bangalore India-

Dr Adarsh M Patil 1 copyDr Adarsh M Patil mbbs ms  Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.

He has experience of treating numerous Parathyroid gland surgery patients in Bangalore .

He believes in that Patient safety comes first and strives to provide exceptional service to patients.

Call Now !  –+91- 9972446882

                                                               Email- adarsh1982p@gmail.com

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Parathyroid gland surgery in Bangalore India & Cost

Hyperparathyroidism

  • Hyperparathyroidism (HPT) refers to hypercalcemia caused by inappropriate parathyroid hormone (PTH) release from the parathyroid glands. Primary HPT results from autonomous release of PTH from parathyroid adenoma or hyperplastic parathyroid glands. Secondary HPT results from a defect in mineral homeostasis (e.g., renal failure), with a compensatory increase in parathyroid function. Tertiary HPT results from the development of autonomous, calcium- insensitive parathyroids after prolonged secondary stimulation (e.g., prolonged renal failure).
  • Parathyroid gland surgery in Bangalore & Cost

Primary HPT

Incidence- 

Primary HPT has an incidence of 0.25 to 1.00 per 1,000 population in the United States and is especially common in postmenopausal women. It most often occurs sporadically, but it can be inherited alone or as a component of familial endocrinopathies, including MEN types 1 and 2A.

The more common clinical findings-

associated with HPT include nephrolithiasis, osteoporosis, hypertension, and emotional disturbances. The widespread use of the multichannel autoanalyzer has led to more patients being diagnosed with “asymptomatic” hypercalcemia or with earlier symptoms, such as muscle weakness, polyuria, anorexia, and nausea. When they are carefully questioned, many patients with HPT turn out to be symptomatic.

Differential diagnosis of hypercalcemia

includes HPT, malignancy, granulomatous disease (e.g., sarcoidosis), immobility, hyperthyroidism, milk-alkali syndrome, and familial hypocalciuric hypercalcemia (FHH). Patients with hypercalcemia and suspected HPT at a minimum should have their serum calcium, phosphate, creatinine, and PTH measured. The diagnosis of HPT is biochemical and requires demonstration of hypercalcemia (serum calcium >10.5 mg/dL) and an elevated PTH level. Currently, the assay of choice for PTH is the highly sensitive and specific intact PTH level radioimmunoassay for Parathyroid gland surgery in Bangalore. Free calcium level (ionized calcium) is a more sensitive test of physiologically active calcium and is the test of choice for hypercalcemia. Hypercalcemia without an elevated PTH can be due to a variety of causes (especially malignancy, Paget disease, sarcoidosis, and milk-alkali syndrome) that must be excluded. Serum alkaline phosphatase is elevated in 10% to 40% of patients with HPT, and serum phosphate is decreased in 50% of patients with HPT if renal function is normal. Elevated PTH promotes bicarbonate excretion, causing hyperchloremic metabolic acidosis; the chloride-phosphate ratio exceeds 33 in 96% of patients with HPT (Ann Intern Med 1974;80:200). Radiographic features of HPT are seen in advanced cases and include decreased bone density, osteitis fibrosa cystica, and the pathognomonic sign of subperiosteal bone resorption on the radial aspect of the phalanges of the second or third digits of the hand.

Endocrine Surgeon In Bangalore-

Dr Adarsh M Patil 1 copyDr Adarsh M Patil mbbs ms  Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.

He has experience of treating numerous Parathyroid gland surgery patients in Bangalore .

He believes in that Patient safety comes first and strives to provide exceptional service to patients.

 Call Now ! –+91- 9972446882

Preoperative localization of parathyroid adenomas

is generally not necessary before a careful neck exploration by an experienced endocrine surgeon, as stated by the 1991 National Institutes of Health consensus conference. However, current practice makes use of several techniques to facilitate limited neck exploration to ensure a high success rate and optimal cosmesis in the outpatient setting. These techniques include radio- and/or image-guided exploration (sestamibi- or ultrasound-guided), videoscopic exploration, and intraoperative intact PTH level monitoring (Surgery 1997;122:1107) for Parathyroid gland surgery in Bangalore. The most frequently applied approach is preoperative sestamibi scanning, followed by direct excision of the scan-identified gland and confirmation of cure by intraoperative PTH measurement. This intraoperative test requires the availability of a rapid assay of intact PTH, which confirms the success of the surgery immediately if the PTH level falls more than 50% 10 minutes after the apparent source of PTH has been removed. If the preoperative localization scan is not informative, then the standard full neck exploration is appropriate.

Parathyroidectomy -Parathyroid gland surgery in Bangalore 

is indicated for all patients with symptomatic HPT. Nephrolithiasis, bone disease, and neuromuscular symptoms are improved more often than renal insufficiency, hypertension, and psychiatric symptoms. Parathyroidectomy for asymptomatic HPT is somewhat controversial. A recent large prospective study of patients with asymptomatic HPT found that 27% developed symptoms of hypercalcemia with 10-year follow-up (N Engl J Med 1999;341:1249). Accepted indications include markedly elevated serum calcium, hypercalcemic crisis, reduced creatinine clearance, asymptomatic kidney stones, markedly elevated urinary calcium excretion, and advanced osteoporosis. Close observation is required for patients not treated surgically.
Neck exploration and parathyroidectomy for HPT result in normocalcemia in more than 95% of patients when performed by an experienced surgeon without any preoperative or intraoperative localization studies. The neck is exposed through a transverse cervical incision. The patient is typically under general anesthesia, although current localization techniques increasingly allow the use of local or regional anesthesia. A thorough, orderly search and identification of all four parathyroid glands are the cornerstones of the standard surgical management of HPT. Parathyroid glands are red-brown to yellow and flat or oval, with a characteristic vascular architecture; however, it may be difficult to distinguish them from fat or lymphoid tissue. Superior parathyroid glands develop from the fourth pharyngeal pouch and most commonly are located dorsally along the middle or upper thyroid lobe, near the intersection of the inferior thyroid artery and recurrent laryngeal nerve, dorsal to the nerve. Ectopic superior glands usually are found posteriorly in the tracheoesophageal groove or cranial to the superior thyroid pole, or rarely in the posterior mediastinum. Inferior parathyroid glands develop in conjunction with the thymus from the third pharyngeal pouch, are more variable in position than are the superior glands, and usually are located ventral to the recurrent laryngeal nerve at the inferior pole of the thyroid lobe within the thyrothymic ligament. Ectopic inferior glands are most likely found embedded in the thymus in the anterior mediastinum. The parathyroid gland is normally about 3 mm by 6 mm and weighs 25 to 40 mg. Determination that a parathyroid gland is abnormally enlarged is best made by the surgeon at the time of operation and not by hypercellularity or other features on histologic examination. Most often, a single adenomatous gland is found; the other, normal parathyroid glands should be left in place. Routine biopsy of normal parathyroid glands is expensive, risks devascularization of the glands, and is not routinely necessary. Occasionally, multiple parathyroid adenomas are found, which should be removed, leaving at least one normal parathyroid behind. Management of four-gland parathyroid hyperplasia is controversial and may include total parathyroidectomy and parathyroid autotransplantation or 3.5-gland parathyroidectomy. The dictation of a clear, factual operative note detailing the identification and position of each parathyroid gland is essential. This information is invaluable in the unlikely event of reoperation for persistent or recurrent HPT for Parathyroid gland surgery in Bangalore.
Familial primary HPT may occur alone or as a component of MEN type 1 and type 2A. HPT in these syndromes is primarily chief cell hyperplasia and variable enlargement of all four glands. These patients have a higher incidence of recurrent or persistent hypercalcemia after parathyroidectomy. Familial benign hypocalciuric hypercalcemia (FHH) is an autosomal dominant form of HPT in which affected family members have mild hypercalcemia, hypocalciuria (urinary excretion of <100 mg of calcium daily), and hypomagnesemia and rarely develop renal or bone complications (J Pediatr 1972;17:1060). Parathyroidectomy is ineffective for FHH.

Endocrine Surgeon In Bangalore-

Dr Adarsh M Patil 1 copyDr Adarsh M Patil mbbs ms  Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.

He has experience of treating numerous Parathyroid gland surgery patients in Bangalore .

He believes in that Patient safety comes first and strives to provide exceptional service to patients.

Call Now ! –+91- 9972446882

 

Hypercalcemia from secondary and tertiary HPT

is treated initially with dietary phosphate restriction, phosphate binders, and vitamin D supplementation. Patients with medically unresponsive, symptomatic HPT (e.g., bone pain and osteopenia, ectopic calcification, or pruritus) may be surgically treated with total parathyroidectomy and heterotopic autotransplantation.
Reoperative parathyroid surgery may be necessary for persistent or recurrent HPT. In all cases, HPT must be reconfirmed biochemically, and 24-hour urinary calcium should be obtained to exclude FHH for Parathyroid gland surgery in Bangalore. Preoperative localization is mandatory and includes careful review of the operative note from the initial surgery and concordant noninvasive studies. Approximately 70% to 80% of patients undergoing reexploration after an initial failed operation have a missed gland that is accessible through a cervical incision. Reoperative parathyroid surgery carries a substantially higher risk of injury to the recurrent laryngeal nerve and of hypocalcemia due to postoperative scarring and disruption of normal tissue planes for Parathyroid gland surgery in Bangalore.
Preoperative localization of the hyperfunctioning parathyroid should be attempted in nearly all reoperative cases by 99mTc-sestamibi scintigraphy and ultrasound or CT scanning. These noninvasive studies are successful in localizing the missed gland in 25% to 75% of cases (Radiology 1987;162:133). With combined use of CT scan, ultrasonography, and scintigraphy, at least one imaging study identifies the tumor in more than 75% of patients. Noninvasive localizing studies must be interpreted in the context of the operative note. Invasive imaging tests, including angiography, are associated with greater morbidity and measurable mortality; they should be reserved for complex cases with negative or equivocal noninvasive studies. The success of these tests in localizing the concealed tumor is highly dependent on the skill and experience of the radiologist (Radiology 1987;162:138). Invasive studies are most helpful for identifying rare glands located outside the patient’s neck (e.g., mediastinum).

Operative strategy.

The goal of reexploration is to perform an orderly search based on the information gained from the initial operation and from localization studies.
Missed parathyroid glands are found either in the usual position or in ectopic sites, as determined by the embryology of parathyroid development. Rarely, a parathyroid gland is intrathyroidal (especially in patients with multinodular goiter), and intraoperative thyroid ultrasound followed by thyroid lobectomy can be performed if an exhaustive search fails to identify the parathyroid adenoma. If four normal glands have been located, the adenoma is likely to represent a supernumerary (fifth) gland. Intraoperative ultrasound is an effective tool for localizing parathyroid glands for Parathyroid gland surgery in Bangalore.
Mediastinal adenomas within the thymus are managed by resecting the cranial portion of the thymus by gentle traction on the thyrothymic ligament or by a complete transcervical thymectomy using a specialized substernal retractor (Ann Surg 1991;214:555). Median sternotomy carries a higher morbidity and increased postoperative pain, and the possibility of these should be discussed with the patient preoperatively.
  • Parathyroid autotransplantation

    • Indications for total parathyroidectomy and heterotopic parathyroid autotransplantation include HPT in patients with renal failure, in patients with four-gland parathyroid hyperplasia, and in patients undergoing neckreexploration in which the adenoma is the only remaining parathyroid tissue. The site of parathyroid autotransplantation may be the sternocleidomastoid muscle or the brachioradialis muscle of the patient’s nondominant forearm. Parathyroid grafting into the patient’s forearm is advantageous if recurrent HPT is possible (e.g., MEN type 1 or 2A). If HPT recurs, the hyperplastic parathyroid tissue may be partially excised from the patient’s forearm under local anesthesia for Parathyroid gland surgery in Bangalore .

    • Technique. Freshly removed parathyroid gland tissue is cut into fine pieces approximately 1 mm by 1 mm by 2 mm and placed in sterile iced saline. An incision is made in the patient’s nondominant forearm, and separate intramuscular beds are created by spreading the fibers of the brachioradialis with a fine forceps. Approximately four to five pieces are placed in each site, and a total of approximately 100 mg of parathyroid tissue are transplanted. The beds are closed with a silk suture to mark the site of the transplanted tissue. Transplanted parathyroid tissue begins to function within 14 to 21 days of surgery.
    • Cryopreservation of parathyroid glands is performed in MEN patients and all patients who may become aparathyroid after repeat exploration. Cryopreservation may be performed by freezing approximately 200 mg of finely cut parathyroid tissue in vials containing 10% dimethyl sulfoxide, 10% autologous serum, and 80% Waymouth medium. Cryopreserved parathyroid tissue can be used for autotransplantation in patients who become aparathyroid or in patients with failure of the initial grafted parathyroid tissue.
  • Postoperative hypocalcemia

    • Transient hypocalcemia commonly occurs after total thyroidectomy or parathyroidectomy and requires treatment if it is severe (total serum calcium <7.5 mg/dL) or if the patient is symptomatic. Chvostek sign (twitching of the facial muscles when the examiner percusses over the facial nerve anterior to the patient’s ear) is a sign of relative hypocalcemia but is present in up to 15% of the normal population. This sign is not necessarily an indication for calcium replacement.
    • Patients with persistent hypocalcemia after total thyroidectomy or after parathyroid autotransplantation can require continued supplementation for 6 to 8 weeks postoperatively. Usually, patients are given calcium carbonate, 500 to 1,000 mg orally 3 times per day, and 1,25-dihydroxyvitamin D3, 0.25 µg orally per day.
    • Hypocalcemic tetany is a medical emergency that is treated with rapid intravenous administration of 10% calcium gluconate or calcium chloride until the patient recovers. Specifically, 1 to 2 ampules (10 to 20 mL) of 10% calcium gluconate are given intravenously over 10 minutes, and the dose may be repeated every 15 to 20 minutes, as required. Subsequently, a continuous infusion of 10% calcium gluconate (90 mg elemental calcium/10 mL), 60 mL in 500 mL D5W (1 mg/mL), is initiated at 0.5 to 2.0 mg/kg per hour to maintain the serum calcium at 8 to 9 mg/dL. Patients with severe hypocalcemia also must have correction of hypomagnesemia for Parathyroid gland surgery in Bangalore.
  • Parathyroid carcinoma-

is rare and accounts for less than 1% of patients with HPT. Approximately 50% of these patients have a palpable neck mass, and serum calcium levels may exceed 15 mg/dL.

Diagnosis is made by the histologic finding of vascular or capsular invasion, lymph node or distant metastases, or gross invasion of local structures.
  • Surgical treatment is radical local excision of the tumor, surrounding soft tissue, lymph nodes, and ipsilateral thyroid lobe when the disease is recognized preoperatively or intraoperatively. Reoperation is indicated for local recurrence in an attempt to control malignant hypercalcemia.

    Patients with parathyroid carcinoma and some patients with benign HPT may develop hyperparathyroid crisis. Symptoms of this acute, sometimes fatal, illness include profound muscular weakness, nausea and vomiting, drowsiness, and confusion. Hypercalcemia (16 to 20 mg/dL) and azotemia are usually present. Ultimate treatment of “parathyroid crisis” isparathyroidectomy; however, hypercalcemia and volume and electrolyte abnormalities should be addressed first. Treatment is warranted for symptoms or a serum calcium level greater than 12 mg/dL. First-line therapy is infusion of 300 to 500 mL per hour of 0.9% sodium chloride (5 to 10 L per day intravenously) to restore intravascular volume and to promote renal excretion of calcium. After urinary output exceeds 100 mL per hour, furosemide (80 to 100 mg intravenously every 2 to 6 hours) may be given to promote further renal sodium and calcium excretion. Thiazide diuretics impair calcium excretion and should be avoided. Hypokalemia and hypomagnesemia are complications of forced saline diuresis and should be corrected. If diuresis alone is unsuccessful in lowering the serum calcium, other calcium-lowering agents may be used. These include the bisphosphonates pamidronate (60 to 90 mg in 1 L 0.9% saline infused over 24 hours) and etidronate (7.5 mg/kg intravenously over 2 to 4 hours daily for 3 days); mithramycin [25 µg/kg intravenously over 4 to 6 hours daily for 3 to 4 days (malignant hypercalcemia only)]; and salmon calcitonin (initial dose, 4 IU/kg subcutaneously or intramuscularly every 12 hours, increasing as necessary to a maximum dose of 8 IU/kg subcutaneously or intramuscularly every 6 hours). Orthophosphate, gallium nitrate, and glucocorticoids also have calcium-lowering effects.

    Parathyroid gland surgery in India.

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Parathyroid gland surgery in India.

Approximate cost is 150000 to 350000 INR based on type of hospital and patient condition

  • Endocrine Surgeon In Bangalore-

    Dr Adarsh M Patil 1 copyDr Adarsh M Patil mbbs ms  Is one of the leading surgeons in Bangalore .15 years of experience in eminent hospitals like Manipal Hospital, Apollo Hospitals and Narayana Hrudalaya in Bangalore.

    He has experience of treating numerous Parathyroid gland surgery patients in Bangalore .

    He believes in that Patient safety comes first and strives to provide exceptional service to patients.

    Call Now ! –+91- 9972446882

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