Cheryl Martin (Host): Problems with your thyroid can produce a wide variety of conditions affecting your heart rate, mood, energy level, metabolism, bone health, and more. Dr. Tim Beck, an endocrine surgeon, is here to discuss thyroid disorders, specifically hyperparathyroidism, and advanced treatment options now available.

 This is Hello Healthy, a Dignity Health podcast. I'm Cheryl Martin. Dr. Beck, great to have you on.

Dr. Tim Beck: Good morning. Thank you so much for having me. It's a pleasure and a privilege.

Host: First, let's start with a basic question. What does the thyroid gland do?

Dr. Tim Beck: So, the thyroid gland is particularly important for control of the metabolism. It plays a number of different roles. But the main one that most patients or most people know the thyroid gland for is to regulate the metabolism, which when it's overactive, then people start losing weight. They become anxious. If it's underactive, then sometimes there can be sluggishness and weight gain.

Host: What are the parathyroid glands?

Dr. Tim Beck: Parathyroid glands, which are probably part of my favorite organ system, not particularly well known to most people. Typically, I first clarify that they're actually not part of the thyroid. They are separate glands that live right next to the thyroid. Most people have four of them, the vast majority of people, and they control calcium levels. That's really the only job they have.

Host: Elaborate on the effect thyroid disorders have on our bodies.

Dr. Tim Beck: So for thyroid disorders, as I had briefly mentioned in the beginning, the thyroid can be hyperactive, which means too active, where it produces too much hormone, or it can be underactive, which is called hypothyroidism. When it's overactive, people often see anxiety, weight loss, and sometimes if it's due to autoimmune diseases like Graves disease, for example. They have a variety of other additional symptoms that can arise. And then, when it's underactive, It produces this sluggishness where people just feel drained without any energy, and there can be weight gain associated with that as well.

Host: Dr. Beck, what is hyperparathyroidism?

Dr. Tim Beck: So, to clarify again the separation between the thyroid and the parathyroids, there's a little bit of a difference between the two which can be sometimes a little bit confusing to patients. When parathyroids become hyperactive, what happens is that they start to produce what's called parathyroid hormone at excessive levels. And this results in the body absorbing bone, typically calcium from the bone and an increased uptake in the intestines. And that results in a high level of calcium within the blood.

Host: And how is it typically found and diagnosed?

Dr. Tim Beck: The way it's typically found and diagnosed is using laboratory results. So oftentimes the primary care provider or an endocrinologist will order routine labs, and then they see that the calcium is elevated. And hyperparathyroidism is actually the most common cause for elevated calcium in the outpatient setting. And that can be particularly concerning because what it can lead to, this continuous high calcium, it can lead to kidney stones. It can also cause what is known as osteoporosis or brittle bones because the parathyroids lead to continuous leaching of calcium from the bones.

Host: So, a patient wouldn't necessarily have any symptoms that would indicate hyperparathyroidism.

Dr. Tim Beck: Correct. Actually, the majority of patients that have hyperparathyroidism are unaware and are not symptomatic. And it is found then, as I said, on labs. And then oftentimes when we talk to the patients, "Have you had kidney stones?" They may say yes, and previously it was unknown why, or we do a bone density scan and we find that they have brittle bone disease, and that may be due to parathyroids being overactive, or a number of less well defined symptoms such as brain fogginess, fatigue, all of that in part can be due to hyperactive parathyroids and high calcium levels.

Host: So, what's the best treatment?

Dr. Tim Beck: The best treatment for otherwise healthy patients is typically surgery, which is really the only way to cure overactive parathyroids. Now, for some patients, it may be appropriate to treat it medically. But as I said that medical treatment does not cure hyperparathyroidism and is oftentimes just a Band-Aid to manage disease until a patient can get to the point where they can have surgery.

Host: And talk more about the kind of surgery this is and how it's done.

Dr. Tim Beck: in general, it's a very safe operation. it's one of my favorite operations as well. I do it through a small incision, over the neck, about 4 centimeters or so. And then, my practice is always to look for all four parathyroid glands. We have two on the right side of the neck and two on the left side.

And then, I take out the abnormal parathyroids. Abnormal parathyroids are bigger and firmer than normal ones, so they're fairly easy to identify in the operating room. I would say that 85% of the time, it's only one of the four parathyroid glands that is abnormal. Sometimes it's two. And at times, it can even be all four. That happens about 5% of the time. If it's all four, then I typically take out three and a half of the glands and patients are still absolutely wonderful afterwards.

Host: How long is the surgery?

Dr. Tim Beck: The surgery typically takes me about an hour and a half. The patient is completely asleep during the operation with a breathing tube. So, they don't have any recollection of the surgery. And, of course, as I said, they're being monitored by the Anesthesia team. And after surgery, I typically just watch the patient for three hours in the recovery area and the majority of my patients go home the same day if they feel well.

Host: And will a patient feel any differently, or will this change them in any way?

Dr. Tim Beck: So, the majority of patients do feel differently, especially if they had severe symptoms of fatigue, of forgetfulness, of this general brain cloudiness, those patients tend to feel better within hours of having had the surgery, at least to some degree. Of course, I cannot guarantee that this improves 100%, because there's so many different reasons why one might be getting a little bit forgetful or is fatigued, but we do see that in the majority of patients that there's at least some improvement. In terms of bone density, for example, that tends to improve within a few months.

Host: Now, when a primary care physician notices this elevated calcium, is that when the primary care physician would then direct the patient to reach out to you with your specialty?

Dr. Tim Beck: Yes, absolutely. Depends on the primary care's comfort level when it comes to managing hyperparathyroidism, because there's certain additional laboratory tests that can be done. For example, we oftentimes look for calcium in the urine as well, because a higher amount, a larger amount of calcium is oftentimes secreted. That's why there's also the link to kidney stones. And sometimes we get some additional imaging of the neck prior to discussing surgery. But as soon as the high calcium is detected, it will be completely appropriate to refer the patients to an endocrine surgeon or to any surgeon who specializes in parathyroid surgery, such as myself.

Host: Anything else, Dr. Beck, you'd like to add regarding hyperparathyroidism or any other thyroid disorders?

Dr. Tim Beck: I think it's important for the community to realize that hyperparathyroidism is much more common than most people realize. Initially, it was thought that it's maybe one in a thousand or so. But it seems that it's much more common than that. And as I said, it really is the most common reason for high calcium levels in outpatients. So, I think it's important to raise awareness regarding this disease.

Host: And once again, calcium levels are included in your basic level blood work.

Dr. Tim Beck: Absolutely. And what's important is that, once it's realized that the calcium is elevated, that's when it's important to check the parathyroid hormone levels. It's just a regular blood test, but that is typically not ordered routinely. That's something that needs to be done additionally.

Host: Dr. Tim Beck, thank you so much for educating us on thyroid disorders and especially on hyperparathyroidism. Thank you so much. Very informative.

Dr. Tim Beck: My pleasure. Thank you so much for having me.

Host: To learn more, visit dignityhealth.org/bakersfield. If you found this podcast helpful, please share it on your social media and check out the entire podcast library for other topics of interest to you. Thanks for listening to Hello Healthy, a Dignity Health podcast.