Monday, May 9, 2011

What Your Thyroid Cancer Doctor Forgot To Tell You

I recently ran into another patient who suffered terribly as a result of their doctor forgetting to tell them an important detail about their surgery.  In this case, it was a thyroid cancer patient who underwent total thyroidectomy and ended up in the hospital mere days later - alone.

Do you think she was frightened when her pulse raced, her BP went high as a kite and her limbs began to spasm uncontrollably?  You bet!

The sad thing is, she should have known this might happen to her and she didn't.  It resulted in a frantic call and an ambulance ride.

Unfortunately for thyroid cancer patients, removal of this small gland in your neck is not as easy as it might seem.  Not only does the thyroid tend to be a bit touchy (see Thyroid Storm) but it normally spends its life in an intimate embrace with a group of tiny rice-like glands called the Parathyroids which, when disturbed can get rather angry and a bit depressed.

Parathyroid glands

Your parathyroids are tiny rice sized little glands found between your thyroid and your esophagus.  Their purpose... to control the calcium in your body.

Think this sounds like an easy job?  It's not.  In fact, without our parathyroid glands doing their busy work *just right* we would die.

In the case of thyroidectomy, not only does the patient need to be aware of the possibility of a thyroid storm during or shortly after surgery, but they should be told about the parathyroid's propensity for drama when disturbed or damaged.

A skilled head and neck surgeon will carefully handle the thyroid in effort to keep the gland from dumping excessive hormone into the patient's system, but he/she will also handle it very carefully because he/she doesn't want the tiny parathyroid glands right beneath the thyroid to be damaged.  When these glands suffer injury, they tend to stop functioning.  This is called hypoparathyroidism and it is a fairly rare condition because we usually the surgeon working on a patient is skilled enough to avoid damaging the parathyroids.  When this injury occurs however, a serious calcium deficiency will result in hours or days.

What about blood calcium?

Calcium and phosphorous work together in balance.  When one is low, the other has a tendency to be high.

Calcium serves many functions in the human body including being responsible for: 1) electrical stimulation to our nervous system 2) electrical stimulation of muscles (including the heart) 3) bone strength.  Blood calcium also helps in influencing the clotting process in our blood and our mood and sense of well being.

Hypoparathyroidism Symptoms

The symptom of hypoparathyroidism is low calcium.  Yes, the PTH (parathyroid hormone) is also low, but the only function of PTH is to control calcium, so this only results in aberrant calcium levels and associated symptoms.  Symptoms can range from very mild, to life threatening and include:

++ tingling around the mouth and in the hands
++ muscle cramps (tetany)
++ seizures/convulsions

Why hypoparathyroidism?

This condition is rare, because most surgeons become skilled in the removal of thyroid tissue before they begin operating alone on patients.  In some cases the surgeon is not as skilled as he should be and these glands are accidentally removed or damaged.  Sometimes the surgeon knows this has happened... sometimes he doesn't.  Either way, a skilled surgeon is extremely unlikely to have a patient with hypoparathyroidism unless he has made a mistake.

There are side effects and contraindications to every surgery.  Every surgery carries with it the risk that something bad can happen to you.  Hypoparathyroidism is almost always preventable.  That said, every doctor should tell every patient before every surgery that hypoparathyroidism is a possible outcome.  They should also be told the treatment for it:  A calcium supplement.

If you suspect that you or someone you know may have hypoparathyroidism, seek immediate medical attention.  Try to keep the patient calm and inactive.  If you choose to call ambulance personnel, tell them your patient has had a thyroidectomy and what his/her symptoms are so the ambulance crew can be prepared.  This gives them the opportunity to talk to each other and to a doctor if they have access to one in preparation for their visit.  In the meantime, talk to the patient and take a medical history in writing.  What medicines do they take and how much as well as when?  When did they last eat?  Who are their doctors?  What medical conditions do they have?  Allergies?  Be specific.  Doing this is very helpful to the ambulance personnel who will try to help you, but it will also keep the patient's mind off their spasms etc.  If the patient has calcium tablets nearby, they might wish to try to take one in case it may help.  However, doing this may alter blood levels leading to a delayed diagnosis by physicians.    

In this article, it's estimated that 60% of physicians never tell their patients that their parathyroid glands may be injured or removed accidentally during surgery and hypoparathyrodism may result.  It also notes that during their study, the odds that a patient may end up with hypoparathyroidism was almost always dependent upon the number of surgeries the physician performed on a regular basis.  It also notes that when questioned, physician overestimated the number of surgeries they performed twice over!  Moreover, 61% of patients reported that their surgeon never told them the reason for their hypoparathyroidism was a mistaken removal of their parathyroid glands!

For more information on parathyroidism, see the Hypoparathyroidism Association Inc.

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