Author: Rodrigo Arrangoiz MS, MD, FACS, FSSO

👉Did you know that the only cure for primary hyperparathyroidism is surgery?

👉Dr. Rodrigo Arrangoiz is Pioneer in Mexico in radio-guided minimally invasive parathyroidectomy.

https://m.youtube.com/watch feature=youtu.be&v=AgvQmtz1gnA

👉Find more info at http://www.hiperparatiroidismo.info

#Arrangoiz

#ParathyroidExpert #ParathyroidSurgeon #Hiperparatiroidismo #Hipercalcemia #CheckYourCalcium #HeadandNeckSurgeon #EndocrineSurgeon

#Hyperparathyrodism

#CirujanodeParatiroides

#ExpertoenParatiroides

#SociedadQuirurgica

👉4D-CT scans are more sensitive than sestamibi scans or ultrasound for tumor localization in recurrent parathyroid disease.

👉CheckYourCalcium (realízate un calcio total ensangre).

#CheckYourCalcium #Arrangoiz #ParathyroidExpert #ParathyroidSurgeon #Hiperparatiroidism #Hipercalcemia #CheckYourCalcium #HeadandNeckSurgeon #MountSinaiMedicalCenter #MSMC #Miami #Mexico #Hyperparathyroidism

👉Find more info at http://www.hiperparatiroidismo.info and https://www.ncbi.nlm.nih.gov/pubmed/29484563

👉The overproduction of parathyroid hormone (PTH), termed hyperparathyroidism (HPT), can be categorized as primary, secondary, or tertiary.

👉Primary hyperparathyroidism (PHPT) arises from an unregulated overproduction of PTH from an abnormal parathyroid gland.

👉Increased PTH levels may also occur as a compensatory response to hypocalcemic states resulting from chronic renal failure or gastrointestinal (GI) malabsorption of calcium. This secondary HPT can be reversed by correction of the underlying problem (e.g., kidney transplantation for chronic renal failure).

👉However, chronically stimulated parathyroid glands may occasionally become autonomous, resulting in persistence or recurrence of the hypercalcemia after successful renal transplantation, resulting in tertiary HPT. This review paper will focus on PHTP

#Arrangoiz #ParathyroidSurgeon #ParathyroidExpert #Hyperparathyroidism #EndocrineSurgery #Hypercalcemia #MountSinaiMedicalCenter #MSMC #Miami #Mexico

👉The changes in calcium and phosphate that result from renal hyperparathyroidism may increase calcification of the arteries leading to heart attacks and strokes.

👉Learn more at https://www.atherosclerosis-journal.com/article/S0021-9150(18)31349-2/fulltext

👉CheckYourCalcium (realízate un calcio total en sangre).

👉Para más información: http://www.hiperparatiroidismo.info

#CheckYourCalcium #Arrangoiz #ParathyroidExpert #ParathyroidSurgeon #Hiperparatiroidism #Hipercalcemia #CheckYourCalcium #HeadandNeckSurgeon #MountSinaiMedicalCenter #MSMC #Miami #Mexico #Hyperparathyroidism

• Focused parathyroidectomy:
  • Is the preferred approach in patients who have a solitary lesion:
    • That is imaged conclusively by:
      • Ultrasound, sestamibi, or other appropriate imaging modalities
• If the surgeon is not attempting to visualize all four glands:
  • The use of IOPTH:
    • To determine whether all hyperfunctioning tissue has been removed and to document an appropriate drop in PTH levels after the removal of the suspected gland:
      • Is the standard of care
• The most common criterion used:
  • Is a 50% or greater reduction in the PTH level from the baseline 10 minute after parathyroidectomy
• The best clinical marker of single-gland disease:
  • Is concordant preoperative imaging:
    • In combination with an appropriate correction of IOPTH levels
• Previous neck surgery or lack of concordant imaging on two types of studies:
  • Is not a contraindication to attempting focused parathyroidectomy
• Patients suspected of having multigland disease are managed by four-gland exploration via a smaller incision

#Arrangoiz #ParathyroidSurgeon #ParathyroidExpert #Hypercalcemia #PHPT #Hyperparathyroidism #PrimaryHyperparathyroidism #EndocrineSurgery #HeadandNeckSurgeon #CancerSurgeon #Surgeon #Teacher #Miami #Mexico #MountSinaiMedicalCenter #MSMC

👉Per American Association of Endocrine Surgeons (AAES) Guidelines, parathyroidectomy is recommended for all patients under 50 with a diagnosis of primary hyperparathyroidism, regardless of the presence of symptoms or physical findings – Dr. Rodrigo Arrangoiz

👉https://jamanetwork.com/journals/jamasurgery/fullarticle/2542667

👉For more information: http://www.hiperparatiroidismo.info

#Arrangoiz #ParathyroidExpert #ParathyroidSurgeon #Hyperparathyroidism #Hipercalcemia #HeadandNeckSurgeon #MountSInaiMedicalCenter #MSMC #Miami #Mexico #Hiperparatiroidismo #ExpertoenParatiroides #CirujanodeParatiroides

• Exposure of the Prevertebral Fascia:
  • The first step in identifying the superior gland:
    • Is to locate the inferior thyroid artery (ITA)
  • The ITA is a crucial reference point for the location of the superior parathyroid gland:
    • The superior parathyroid gland is usually found in an area 1 cm cranial to the ITA
  • Once the ITA has been identified, blunt dissection cranial to the artery and directly posterior is performed down to the shiny prevertebral fascia
  • The prevertebral fascia defines the posterior extent of the dissection, and the most posterior location possible for a superior parathyroid gland
• Visual:
  • Although it is tempting to dive straight in and attempt to dissect the first piece of tissue that resembles parathyroid tissue, considerable time and effort can be saved by slowly and deliberately confirming the key landmarks and looking for some of the morphological features described in section “Pearls for Identification of Parathyroid Glands” (published in a previous Blog)
  • The identification of a parathyroid gland begins withcareful visual inspection:
    • Start by looking for a gland or fat pad in a 1 to 2-cm area cranial to the ITA on the posterior surface of the thyroid lobe (Figure 1)
• Digital
  • The superior glands can be found in a number of positions in association with structures from the fourth branchial arch, including:
    • Retropharyngeal
    • Retroesophageal
    • Para-esophageal
    • Adjacent the hyoid bone
  • Further, when a superior gland enlarges:
    • It tends to do so in a posterior and caudal direction and can pass behind the ITA to lie below the inferior gland
  • After careful visual inspection in the area 1 cm cranial tothe ITA, these potential positions are digitally palpatedfor using five maneuvers (Fig. 1.4):
    • The index finger is introduced into the space previously created above the ITA and directly down to the prevertebral fascia / retroesophageal space and then swept along the esophagus to feel in the retroesophageal / retropharyngeal positions
    • The finger is then swung caudally until the finger lies vertically with the tip below the ITA
    • The tissue over the tip of the finger is gently balloted, feeling for an enlarged superior gland to contact the tip of the posterior index finger
    • The finger is then swung back to a horizontal position
    • The finger is withdrawn slowly while the tip remain in contact with the esophagus and trachea, deliberately feeling for the trachea-esophageal groove

#Arrangoiz #ParathyroidSurgeon #ParathyroidExpert #Hyperparathyroidism #Hypercalcemia #HeadandNeckSurgeon #MSMC #MountSinaiMedicalCenter #Miami #Mexico #Surgeon #Teacher

👉Normocalcemic hyperparathyroidism (HPT) is characterized by normal calcium, high PTH levels, and may be a distinct entity that behaves differently than classical HPT.

👉Rodrigo Arrangoiz MS, MD, FACS cirujano de tumores de cabeza y cuello / cirugia endocrina es experto en el manejo del hiperparatiroidismo primario.

👉Introdujo a su país (Mexico) la técnica de exploración bilateral de cuello con valoración de la funcionalidad de las glándulas paratiroides con paratiroidectomia radioguiada:

https://m.youtube.com/watch?v=AgvQmtz1gnA&time_continue=127

👉Su entrenamiento fue el siguiente:

• Cirugia general y gastrointestinal:
• Michigan State University:
• 2004 al 2010• Cirugia oncológica / tumores de cabeza y cuello / cirugia endocrina:
• Fox Chase Cancer Center (Filadelfia):
• 2010 al 2012• Maestria en ciencias (Clinical research for healthprofessionals):
• Drexel University (Filadelfia):
• 2010 al 2012• Cirugia de tumores de cabeza y cuello / cirugiaendocrina
• IFHNOS / Memorial Sloan Kettering Cancer Center:
• 2014 al 2016

#Arrangoiz

#CirugiadeTumoresdeCabezayCuello

#CirugiaEndocrina

#CirugiaOncologica

#HeadandNeckSurgery

#EndocrineSurgery

#SurgicalOncology

#Hyperparathyroidism

#Hiperparatiroidism

#MountSinaiMedicalCenter

#MSMC

#Miami

#Mexico

• Primary hyperparathyroidism (PHPT) is seen in 0.1% to 0.5% of the adult population:
  • It is the most common cause of hypercalcemia (high calcium level) in the general population
  • It is about three times to four times more common in women than men
  • Patients are usually older, with an average age at presentation of 65 years:Most cases are over 45 years
• Learn more at:https://collectedmed.com/index.php/article/article/demo_article_display/7545/83/2/1

#Arrangoiz #ParathyroidSurgeon #ParathyroidExpert #Hyperparathyroidism #PrimaryHyperparathyroidism #CancerSurgeon #EndocrineSurgery #Teacher #Surgeon #HeadandNeckSurgeon #SurgicalOncologist #ParathyroidAdenoma #Hypercalcemia #ElevatedCalciumLevels #Miami #MountSinaiMedicalCenter #MSMC #Mexico #Hialeah

• Primary Hyperparathyroidism (PHPT):
  • Is a common disorder:
    • Affecting 100,000 individuals annually in the United States
  • PHPT occurs in 0.1% to 0.3% of the general population
  • Is more common in women (1:500) than in men (1:2000)
  • Increased PTH production leads to hypercalcemia via:
    • Increased GI absorption of calcium, increased production of vitamin D3, and reduced renal calcium clearance
  • PHPT is characterized by increased parathyroid cell proliferation and PTH secretion:
    • That is independent of calcium levels