Parathyroid Tumors Treatment Program

Overview

The Elizabeth and Michael Ruane Center for Endocrine Tumors at Massachusetts General Hospital Cancer Center is a comprehensive program specializing in the treatment of all types of endocrine conditions, including those of the parathyroid.

The most common parathyroid disorder is an overactivity of the parathyroid gland(s) called primary hyperparathyroidism where the parathyroid glands overproduce the chemical called parathyroid hormone. This results in an elevated level of serum calcium and may cause kidney stones and bone deterioration.

Although most hyperparathyroidism is due to benign (non-cancerous) parathyroid tumors our program combines the resources of the Massachusetts General Hospital Cancer Center and the Mass General Endocrinology Unit and Thyroid Unit to provide advanced treatment for all patients with parathyroid disorders.

Innovative Approaches

Our program is one of the oldest, largest and most specialized in the country in treating parathyroid conditions as well as other disorders of the endocrine system. Among the innovations that make our program distinct are:

• High volume surgical expertise and experience. The most advanced surgical techniques are utilized, including minimally invasive surgery with limited parathyroid explorations, small incisions, and parathyroid hormone monitoring during the operation. In appropriate patients, we also utilize out patient surgery, local anesthesia, and radioguidance (MIRP, minimally-invasive radioguided parathyroidectomy). The first successful operation for hyperparathyroidism in the US was performed at the Mass General
• Highly specialized endocrinology expertise in diagnosing and treating all patients with hyperparathyroidism. We have particular expertise in evaluating and treating patients with familial genetic syndromes such as MENI and MENII syndromes, familial hyperparathyroidism, parathyroid hyperplasia (including those with kidney disease, called secondary hyperparathyroidism), tertiary hyperparathyroidism, mediastinal parathyroid adenomas, and parathyroid cancer. We are also experts in differentiating primary hyperparathyroidism from conditions which mimic hyperparathyroidism such as Familial Hypocalciuric Hypercalcemia
• Advanced clinical trials to find better therapies for patients with parathyroid carcinoma
• Our pathologists have been among the world leaders in the pathological diagnosis of parathyroid tumors including the use of molecular diagnostics when indicated

Diagnostic Expertise

An accurate diagnosis is the key to planning the right treatment. Years ago, the diagnosis of primary hyperparathyroidism was somewhat difficult, but it has been made easier with improvements in our ability to detect the hormone PTH accurately. Hyperparathyroidism can now usually be diagnosed with a simple blood test to detect elevated calcium levels in the blood. If a patient has elevated PTH levels, along with an elevation in serum calcium, the diagnosis is most often primary hyperparathyroidism. Hyperparathyroidism may also be diagnosed when a patient has an elevated serum calcium and a normal parathyroid hormone concentration or a high normal calcium and an elevated parathyroid hormone concentration.

Excellence in Surgical Care

Our endocrine surgery program is one of the oldest in the country, and is recognized for having among the most specialized surgeons in treating parathyroid and endocrine disorders. This level of specialization has resulted in a high volume practice, which research has shown improves outcomes for patients.

Our surgeons use the most state-of-the art technologies, and have pioneered and continue to advance minimally invasive techniques. Our goal is to be as conservative as possible with surgery without compromising care. Extreme attention is paid to the cosmetic appearance of the incision and to make the approach as minimally invasive as possible.

Recently, a new approach to parathyroidectomy has been developed called minimally-invasive parathyroidectomy. This involves smaller incisions, more limited neck exploration, and testing of PTH hormone levels during the operation. In rare and highly selected cases, radioguidance, which uses a special dye that concentrates in the enlarged parathyroid gland, is used as well. A special probe is then used at the time of surgery to help identify the precise location of the parathyroid tumor, allowing for a smaller incision and less disruption to surrounding healthy tissue. The success rate with these new techniques has been extremely high.

Surgical Outcomes & Performance

The Center for Outcomes & Patient Safety in Surgery (COMPASS) ensures that surgical data is transparent and accessible for patients. Watch the video to view Mass General's performance for procedures to treat conditions of the adrenal, thyroid and parathyroid glands.

Developing Better Therapies through Research

Our physician researchers are working at all levels of research to advance therapies for parathyroid conditions as well as all disorders of the endocrine system in order to improve the lives of all our patients.

Multidisciplinary Patient Care

Patients in the Endocrine Tumor Program are often cared for by a coordinated highly specialized multidisciplinary team that includes:

• Endocrinologists with expertise in diagnosing and treating parathyroid conditions, including diagnosing those with familial genetic syndromes involving the parathyroids
• Endocrine Surgeons who are leading the way in performing and developing the most advanced surgical approaches for locating and removing parathyroid tumors
• Radiologists who utilize an array of medical imaging techniques including nuclear medicine parathyroid scans, ultrasounds and innovative 4-Dimensional CT scans to locate parathyroid tumors, including ones with failed previous operations
• Cytologists and Pathologists examine fine-needle aspiration samples and surgical parathyroid pathology specimens. Molecular diagnostics are employed as indicated
• Radiation oncologists who specialize in delivering the optimal therapeutic dose to malignant parathyroid tumors while protecting healthy tissue
• Endocrine (Medical) oncologists who prescribe the most effective chemotherapy and medications for parathyroid carcinoma
• Support services including specialized nursing staff, social workers, psychiatrists, nutritionists and chaplains

Clinical Trials

The Elizabeth and Michael Ruane Center for Endocrine Tumors is conducting clinical trials for patients with advanced endocrine cancers, including ongoing prospective, multidisciplinary studies in benign and malignant thyroid and parathyroid disease.

Find clinical trials for parathyroid tumors.

Find targeted therapy trials for parathyroid tumors.