Washington Manual of Surgery Podcast

Parathyroid Glands - Washington Manual of Surgery

• WashU Medicine Department of Surgery

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Let’s talk parathyroid disease and parathyroidectomy—Join general surgery resident Dr. Abby Chmiel for a discussion with expert endocrine surgeon, Dr. Taylor Brown. This episode of the Washington Manual of Surgery Podcast will cover hyperparathyroidism and serves as an additional companion to Chapter 30 of the 9th edition of the bestselling Washington Manual of Surgery.

In this episode of the Washington Manual of Surgery Podcast, Dr. Brown explores the essentials of parathyroid disease. The discussion gives additional insight into the functions of the glands, recognizing the signs and diagnosis of hyperparathyroidism, understanding when surgery is recommended, and how to safely perform the operation. He concludes with expert guidance on recognizing and managing surgical complications.

Guest Host: 

Abby Chmiel, MD – General surgery resident at WashU Medicine. 

Guest: 

Taylor Brown, MD, MHS – Dr. Brown is an assistant professor of surgery in the Division of Surgical Oncology who specializes in endocrine surgery. 

Show notes:

FHH: "Familial hypocalciuric hypercalcemia", a rare genetic condition causing elevated blood calcium and normal or slightly elevated parathyroid hormone (PTH)

4DCT: Specialized multi-phase CT to locate enlarged or overactive parathyroid glands with the fourth dimension being time, tracking how contrast flows through the tissues to pinpoint abnormal glands.

Guidelines for operating on asymptomatic hyperparathyroidism: Bilezikian JP, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99(10):3561

Positioning in the operating room: modified "beach chair" (e.g., semi-Fowler's) position elevating the patient's upper body to a 30-to-45-degree angle with a shoulder roll to extend the neck.

Miami criteria (iPTH drop >/= 50% from the highest of either pre-incision or pre-excision level at 10 minutes after gland excision): Carneiro DM, et al. Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery. 2003 Dec;134(6):973.

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The Washington Manual of Surgery Podcast is a companion to the Washington Manual of Surgery (9th Edition). For more comprehensive surgical education, pick up a copy of the Washington Manual of Surgery: https://bit.ly/41xJ0aQ

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For more information about the Department of Surgery at WashU Medicine, visit https://surgery.wustl.edu/ and follow us on social media. 

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