Parathyroid surgery recommendations?

[blackrice]

Looking for an experienced parathyroid doctor in Bangkok who specializes in hyperparathyroidism?

Anyone have any suggestions?

;)

[Sheryl]

Do you need a surgeon straight away or further endocrine investigation?  Surgery would be indicated only if it were confirmed to be primary hyperthyroidism due to an adenoma or carcinoms.

 

This is an excellent endocriniologist:

 

https://www.bumrungrad.com/doctors/Jun-Srimanunthiphol

 

She will recommend a surgeon if it is indicated.

 

Even if you have already been definitively diagnosed with a parathyroid adenoma or carcinoma in your home country I would still advise starting with the endocrinologist.

[blackrice]

Thanks a lot, I believe I have hyperparathyroidism and wanted a doctor in BKK to confirm - and suggest a surgeon. The obvious issue is that there doesn't appear to be a lot of clinics / doctors that specialize in the minimally invasive procedure here. (or asia)

 

Most appear to be in the USA.

 

I'll request.a consultation with Jun. Thanks!

[angsila]

I had the surgery 5 years ago. At that time there were no surgeons in Thailand doing the minimally invasive procedure so I had it done in the USA . The surgery was outpatient and took less than 20 min. Before going to the US I saw two endocrinologists in Thailand one at Samitivej and one at Bangkok Hospital. The doctor at BH wanted to also have a Sestamibi scan done for confirmation. I told him that the surgeon would do the scan as she used it for location not diagnosis.

 

The diagnosis for me should have been easy - high yearly calcium 10.5 with high PHT.

 

 

 

[blackrice]

4 hours ago, angsila said:

I had the surgery 5 years ago. At that time there were no surgeons in Thailand doing the minimally invasive procedure so I had it done in the USA . The surgery was outpatient and took less than 20 min. Before going to the US I saw two endocrinologists in Thailand one at Samitivej and one at Bangkok Hospital. The doctor at BH wanted to also have a Sestamibi scan done for confirmation. I told him that the surgeon would do the scan as she used it for location not diagnosis.

 

The diagnosis for me should have been easy - high yearly calcium 10.5 with high PHT.

 

4 hours ago, angsila said:

 

 

 

You had it done in the Tampa center?

What was the outcome - do you feel better? Symptoms relieved? Any problems?

 

My calcium is 10.0 and PTH 62..

[angsila]

My surgery was Seattle, WA as my "US residence" is Sequim, WA. The surgeon DR Kathleen Stickney received her parathyroid surgical training in Tampa at USF (Norman method).

 

Felt better right after surgery, calcium returned to pre condition level of 9.0 only problem was osteoporosis from the 5 years of it not being diagnosed. I had labs/physicals done twice every year once here in Thailand and once in the US and the doctors always just said "your calcium is a little high'. 

[Sheryl]

While hyperparathyroidism is most commonly due to an adenoma (or less often, carcinoma) for which surgery is the treatment, it is sometimes secondary to other causes hence a thorough initial endocrine investigation is essential.

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[angsila]

OP's  calcium of 10.0 and PTH of 62 are high but still in the normal range and as Secondary hyperparathyroidism is not associated with high blood calcium as OP's 10.0, then OP needs to find out if they has a tumor or not and start with an endocrinologist as recommended.

[Sheryl]

Secondary hyperthyroidism can be associated with elevated calcium. The type due to low serum calcium secondary to kidney disease will usually not be because in that instance the elevated PTH is a compensatory mechanism to regulate calcium levels. But there are other types.

 

Labs vary in their reference range but indeed at most labs 10 world fall in normal range for serum calcium and 62 would fall in normal range for PTH. However possible both would be a little outside normal range at some labs.

 

Should also be cautious about forming conclusions based on a single lab measurement. I recently had a quite elevated PTH (almost 100) found incidentally during a bone health workup. Calcium and Vit D levels normal. Repeat test showed normal range PTH.

 

I have to say that in my experience internet based self diagnoses are wrong at least 90% of the time. Anyhow a good endo will get to the bottom of it.

 

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[blackrice]

Sure, thanks for all the good advice. At Bumrungrad now getting my:

 

Serum calcium

Ionized Calcium

Intact PTH

Phosphates

D2/D3

 

Checked now (and seeing an endocrinologist)

I'll do it weekly to build up a picture of what's going on.

 

You're right, I self diagnosed a Para - because the symptoms are so similar (crushing fatigue, anxiety, bone pain, etc etc. I've tested extensively for just about everything else - tumor markers, cancer, Hep C, HIV, immune problem, inflammation (I think they took 12 vials last month for testing)..

 

I was hoping to find an expert with Para - because they could either help rule it in / out.

 

I also did a webcrowd thing where their diagnosis was Para.

 

We shall see.

[Sheryl]

If hyperparathyroidism is ruled out may have to consider CFS or FM. These have no definitive clinical tests and are diagnosed by combination of symptoms plus exclusion of other causes.

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[angsila]

You might also want a DEXA Scan (bone density)

 

Best of luck in taking care of your problem

[mran66]

I got a high calsium result in regular checkup, so would need to consult a doctor for further investigation. I would guess the likely reason is parathyroid as have other light symptoms as well.

 

Anybody would happen to know if any hospital would have capability for the parathyroid operation with minimally invasive operation capability, as daysurgery (in Pattaya or Bangkok)?

In case some place has, might as well book a endrocrinologist in same place as well so that could have the whole treatment chain in one hospital

[Sheryl]

10 hours ago, mran66 said:

I got a high calsium result in regular checkup, so would need to consult a doctor for further investigation. I would guess the likely reason is parathyroid as have other light symptoms as well.

 

Anybody would happen to know if any hospital would have capability for the parathyroid operation with minimally invasive operation capability, as daysurgery (in Pattaya or Bangkok)?

In case some place has, might as well book a endrocrinologist in same place as well so that could have the whole treatment chain in one hospital

 

Thai hospitals tend not to do much day surgery since the cost difference between that and staying overnight is not so different, unlike in the West, and probably not worth the slight increase in risk.

 

I assume by "minimally invasive" what you mean is a "Focused parathyroidectomy". In this a determination is made beforehand of exactly which of the 4 lobes of the parathyroid needs to be removed and the entire gland is not explored surgically. This determination is made through a series of tests which need the involvement of an endocrinologist, It is also an endocrinologist that must make the initial determination that there is a parathyroid mass.

 

In other words you need to start with an endocrinologist and the endo would be the primary physician throughout, referring to a head and neck surgeon for actual surgery if needed. (It is possible it won't be)

 

Your primary concern then should be choice of endocrinologist.  I highly recommend this one:

 

https://www.bumrungrad.com/doctors/Jun-Srimanunthiphol

[mran66]

Okay I see, thanks. Would you happen to know how the investigation/determination process is? Is it a one-time/one or two day thing, or does it something that require several visits to the endocrinologist/hospital over period of several days/weeks for repeated tests? Or tests could be done by local lab even if doc in Bangkok?

 

Just thinking the practical arrangements if done out of home town.

[Sheryl]

1. a number of blood tests, some of them pretty specialized and may not be available at local lab

 

2. ultrasound of the parathyroid (if this is suspected to be a parathyroid condition - possible other cause will be found)

 

3. Sestamibi scintigraphy (sometimes skipped if the US seemed conclusive) this is a specialized type of CT using ainjection of a "tracer" that is picked up by the thyroid

 

If the cause of the elevated calcium does not seem due to a parathyroid tumor then bone scan may also be advised (excessive bone breakdown being another possible cause)

 

It is up to the doctor but most would I think start with blood work only, especially since this is all prompted by a one-off calcium level.. May take a day to get all results. Then Dr reviews it and if indicated schedules an US.  Then maybe the scintigraphy and appt with surgeon.  My guess 3 days probably enough.