Dr. Bredenkamp recieved his medical degree from the University of California, San Francisco School of Medicine. He then went on to serve a six year residency at the University of California, Los Angeles School of Medicine in the department of Surgery.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The anatomy of the parathyroid glands is complicated by two important
structures: the recurrent
laryngeal nerve and the thyroid gland. The recurrent laryngeal nerve is a
very important nerve that runs very close to or through the thyroid gland next
to the parathyroid glands. This nerve controls movement of the vocal cord on
that side of the larynx , and
damage to the nerve can weaken or paralyze the vocal cord. Weakness or
paralysis of one vocal cord causes a breathy weak voice, and difficulty
swallowing thin liquids. Weakness or paralysis of both vocal cords causes
difficulty breathing. In most situations, a special breathing tube is used that
rests in the larynx (voice box) between the vocal cords and is designed to allow
for the continued monitoring of their function. In rare situations, the
parathyroid adenoma is found within the thyroid gland, and it is necessary
to remove the thyroid gland as well. The main goal of the parathyroidectomy
operation is to remove the offending gland(s) while protecting the remaining
normal parathyroid glands as well as the recurrent laryngeal nerves and the
thyroid gland.
Surgery may be unsuccessful, that is, the hyperparathyroidism may not
be cured and there may be
complications of the surgery. Because individuals differ in their response to surgery,
their reaction to the anesthetic and their
healing following surgery, there can be no guarantee made as to the results or
the lack of complications. Furthermore, the outcome of surgery may depend on
preexisting or concurrent medical conditions.
The following complications have
been reported in the medical literature. This list is not meant to be
inclusive of every possible complication. They are listed here for your information
only, not to frighten you, but to make you aware and more
knowledgeable concerning parathyroidectomy. Although many of these complications are rare, all have occurred at one time or another
in the hands of experienced surgeons practicing community standards of care. Anyone
who is contemplating surgery must weigh the potential risks and complications
against the potential benefits of the surgery or any alternative to surgery.
Damage to the recurrent laryngeal nerve with resultant weakness or
paralysis of the vocal cord or cords: This is a rare but serious complication.
Unilateral weakness results in a weak, breathy voice, and there will be
problems swallowing. A second surgical procedure can alleviate many of the symptoms
of unilateral vocal cord paralysis. Bilateral vocal cord
paralysis results in a relative normal voice; however, there is difficulty breathing, and the patient
may ultimately require a tracheotomy. Every effort is made to
protect the recurrent laryngeal nerve. Temporary vocal cord weakness occurs
much more frequently than permanent vocal cord weakness, and it usually
will resolve after several days or within a few weeks. Rarely, a malignant tumor
has already invaded the nerve and has
caused vocal cord weakness or paralysis.
Bleeding or hematoma:
In rare situations, a blood transfusion may be necessary because blood is lost during surgery. Patients can choose to have autologous blood
(their own blood)
or blood from a friend or relative collected in advance of the
surgery in case a transfusion is necessary. The surgeon can make arrangements
for patients interested in these options.
Damage to the remaining parathyroid glands with resultant problems in maintaining
calcium levels in the blood: In most situations, you only need one functioning gland to have normal calcium levels. In
the rare event that all glands are removed, blood calcium
levels may fall, and patients may need to take calcium supplementation
for the rest of their lives.
Need for further and more
aggressive surgery: In some cases, surgical exploration fails to identify the abnormal parathyroid gland
or multiple abnormal glands may be present. Further and more aggressive surgery
may be necessary, such as an extensive surgical exploration of the neck
or chest.
Need for a limited or total thyroidectomy: In
rare situations,
the abnormal parathyroid gland is within the thyroid gland itself or an unexpected thyroid
carcinoma, a
malignant cancer, is identified. In such situations, much or
all of the thyroid gland must be removed, and there may be a need for
life-long thyroid hormone treatment.
Prolonged pain, impaired
healing, need for prolonged hospitalization, permanent numbness of the neck
skin, poor cosmetic result, and/or scar
formation.
Recurrence of the tumor or
failure to cure the tumor despite effective therapy.
Hyperparathyroidism is a disorder of the parathyroid glands. There are two types of hyperparathyroidism, primary and secondary. When the parathyroid glands produce too much hormone, hyperparathyroidism is the resulting condition. Most cases of hyperparathyroidism have no evident cause. Symptoms include fatigue, weakness, depression, loss of appetite, nausea, vomiting, constipation, or confusion. Increased calcium and phosphorous excretion may cause kidney stones. The main treatment of hyperparathyroidism is parathyroidectomy.
In hypoparathyroidism, the parathyroid gland does not produce enough parathyroid hormone. Causes of hypoparathyroidism include injury to the parathyroid glands, autoimmune disorder association, or may be present ab birth. Symptoms of hypoparathyroidism include: tingling fingers, toes, and lips, brittle nails, dry, coarse skin, dry hair; memory loss, headaches, severe muscle cramps, cataracts, malformed teeth, and convulsions. Treatment of hypoparathyroidism is to restore the calcium and phosphorus to normal levels in the body.
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