Delicate, complex surgery cures long-time hyperparathyroid patient
On top of that, Steiner’s thyroid gland—prone to benign nodular growths—had developed a growth so large that it was now descending into her chest cavity and pressing on her windpipe, causing it to narrow.
Now 73, Steiner had already been through two surgeries five weeks apart in the 1990s (at a hospital not affiliated with MultiCare) that failed to resolve her hyperparathyroid disease. As a result, she had lived with faulty parathyroid glands for 25 years.
Hyperparathyroidism is a condition in which the parathyroid glands—tiny glands in the neck that sit behind the thyroid gland—produce too much of the hormone that regulates calcium and phosphorous in the body. In response, blood calcium levels become elevated (which can be dangerous for bones and kidneys), cause a general feeling of unwellness and create other problems.
In Steiner’s case, after her concerning bone scan in the fall of 2020, her primary care physician referred her to William Duke, MD, FACS, a specialized thyroid and parathyroid surgeon at MultiCare.
During Steiner’s visit, Dr. Duke confirmed that without surgically removing Steiner’s faulty parathyroid glands, she would almost certainly develop osteoporosis. And her worsening thyroid condition could eventually cause serious breathing difficulties.
Given the drawbacks of not having surgery, Steiner decided it was time to go ahead. “Dr. Duke didn’t want to rush into surgery and did a lot of testing beforehand. But when he found what he did, it was apparent to all of us that surgery was the best choice,” she said.
The surgical challenge
Steiner’s surgery would be especially challenging due to her thyroid growth and the scar tissue from her two previous surgeries decades earlier. As tiny as a grain of rice, the parathyroid glands could be embedded within the thyroid growth or hidden in the thick, dense scar tissue that ran from Steiner’s thyroid into her chest.
The scar tissue could even block access to the thyroid, requiring an open-chest incision that would be harder for Steiner to heal from. In addition, because scar tissue so closely resembles nerve tissue, Dr. Duke would need to carefully identify and keep safe the laryngeal nerves that run along both sides of the neck to the voice box and govern speaking and breathing.
Then, Dr. Duke would need to recognize and remove each faulty parathyroid gland, only slightly dissimilar to a healthy gland even to a trained eye. Complicating matters further, it would be impossible for him to know even during surgery how many parathyroid glands were there, as not every person has the standard number (four).
A delicate endeavor
“Imagine swimming in a murky lake and you drop your glasses, then dive down to get them. They could be just beyond your fingertips and you can’t even see them. That’s how these reoperative surgeries go,” said Dr. Duke. “The scar tissue is so dense that you can be one cell layer, one tissue layer, away from the goal and not see it at all.”
Dr. Duke began the surgery by making an incision just above Steiner’s collarbone that would later be hidden from view by a natural crease in her skin. Gently, he began to tease the scar tissue away from the thyroid and deliver the thyroid up from within her chest. After a meticulous dissection, the scar tissue finally slipped away to reveal what appeared to be an abnormal parathyroid gland stuck to the top of the thyroid.
After removing the parathyroid gland (along with the rest of the overgrown thyroid tissue from her chest), Dr. Duke sent it to the lab for a quick analysis that confirmed that it was indeed abnormal. Yet after checking Steiner’s bloodwork, he saw that her parathyroid hormone levels hadn’t changed. This meant that another faulty parathyroid gland was still hidden somewhere.
Moving over to the right side of the thyroid, Dr. Duke carefully identified and protected the laryngeal nerves. He then opened the thyroid a little bit and found what he was looking for embedded inside the thyroid gland itself: another abnormal parathyroid gland. This unusual location had been overlooked during Steiner’s previous surgeries.
After Dr. Duke removed the second parathyroid gland, Steiner’s bloodwork results came back from the lab within minutes. “Her hormone levels had dropped down to normal levels again, and at this point she was effectively cured of her parathyroid disease,” said Dr. Duke.
“Feeling better than I have in a long time”
Although Dr. Duke needed to remove Steiner’s thyroid, he was able to do so without opening her chest and was also able to preserve her fourth parathyroid gland, which is functioning well and is expected to continue to perform even better over time.”
As a result, Steiner doesn’t need to take as much calcium supplement as she would have if all her parathyroid glands had been removed. Her recovery is going well, she says, and she is relieved that her bones will be healthy again.
Another apparent outcome from the surgery, which Steiner hadn’t anticipated, is that her depression, which she had struggled with for decades, has suddenly lifted.
Because high calcium levels can lead to mental health symptoms like anxiety and depression, it’s likely that reversing Steiner’s parathyroid disease has also healed her depression, said Dr. Duke.
“Before the surgery, he told me that he expected I’d feel better than I have in a long time. And he’s right. I’m continuing to feel better and better,” she said.
Steiner is grateful. “Dr. Duke has absolutely been amazing and so caring. I had surgery at MultiCare Tacoma General Hospital and everyone there was amazing too. I couldn’t have asked for better care,” she said.
Learn more about thyroid and parathyroid conditions and your treatment options at MultiCare.
