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sep– oct 2014
singapore health
NEWS
03
Cut, mince and jab
A new technique that injects finely minced parathyroid gland tissue into the arm
of a kidney failure patient works better than implanting a bit of the gland
By Thava Rani
S
urgery to remove overactive
parathyroid glands in patients
with kidney failure was often followed up immediately with a small bit
of the gland being implanted into the
arm muscle. This was done to restore the
glands’ function, which could take nearly
nine months to recover.
But a team of surgeons from the
Singapore General Hospital (SGH) and
the National Cancer Centre Singapore
(NCCS) recently found through a retrospective study of 132 patients that injecting a solution containing finely minced
gland tissue into the upper arm got the
parathyroid function up and running
again more quickly. The glands’ function
was restored in just two months, the
study found.
“This new injection method promotes
faster recovery and can be performed
in nearly half the time that the conventional method requires,“ said Dr Jeremy
Ng, Consultant, General Surgery, SGH.
Unlike the previous method of cutting up
muscle to implant the gland, the injec-
(From left) Dr Gopal Iyer, Dr Jeremy Ng
and Associate Professor Lina Choong,
were involved in the study on the new
injection method which promotes
quicker recovery.
Small but
important
thyroid gland
parathyroid
glands
The tiny parathyroid glands, found behind the thyroid, can grow many times
their normal size in some advanced stage renal disease patients.
tion does not leave any scars, and there is
less risk of bleeding or infection.
“If the gland becomes overactive
again, surgeons can get to the injection
site more easily, without having to cut
through muscle again,” said Dr Gopal
Iyer, Senior Consultant, Department of
Surgical Oncology, NCCS.
The study involved 132 patients who
underwent surgery to remove their parathyroid glands between February 2005
and February 2012. The patients’ parathyroid function was restored by either
implantation or injection.
The study was published in Surgery,
a renowned international journal, in
January this year. The injection method,
which carries a lower risk of complications, has become the standard procedure for this condition at SGH. About 130
patients have undergone the procedure.
The tiny parathyroid glands that sit
near the thyroid glands in the neck serve
the very important function of maintaining the right balance of calcium and
phosphate levels in the blood. When this
balance goes out of whack, as is common
among those suffering from poor kidney
function, medication or even surgery is
needed to treat the condition.
“Patients with poor kidney function
have a problem with phosphate because
Implantation or injection?
What isHow longHow long beforescarring? risks
Done
it takes
parathyroid function
is restored Injection
Solution of finely minced
gland injected into fat
under the skin
Implantation
Gland pieces implanted 30min
9 months
4-5cm
into arm muscle
18min
2 months
None
None
Bleeding,
infection
Sometimes too small
to be detected even
by ultrasound,
parathyroid glands
• Are small pea-sized glands,
usually four, located just
behind the butterfly-shaped
thyroid glands in the neck
• Can grow 20-30 times their
normal size when stimulated
to keep producing a hormone
that deals with phosphate and
calcium imbalance
The glands’
Balancing act
• Parathyroid hormone is
released to control levels
of calcium (too low) and
phosphate (too high) in the
body; magnesium too
• Causes kidneys to excrete
excess phosphate in urine
• Causes release of calcium
from bones, calcium to be
absorbed, and stops kidneys
from getting rid of calcium
in urine
Calcium and phosphate
are important in
• Building and repairing bones
and teeth
• Helping nerves to function
• Making muscles contract
• Helping blood to clot
When there is Too
much phosphate
• Kidneys are not able to remove
excess phosphate in urine
effectively when prompted by
hormone
• Parathyroid glands keep
releasing hormone to try and
lower high phosphate level
• Continued discharge of
hormone causes side effects:
more calcium is released from
bones, resulting in slow loss
of support function; released
calcium clogs blood vessels
• Patients may experience bone
and joint pains, fractures and/
or cardiovascular problems
> Continued on page 4
( 华文版本请翻阅至27页 )
04
NEWS
singapore health
sep– oct 2014
> Continued from page 3
Cut, mince and jab
with people suffering from end-stage
renal failure, the signals cannot be
heard and the kidneys cannot get rid
of phosphate easily, leading to phosphate levels staying at elevated levels,
she said. When this occurs for a long
time, bone and cardiovascular diseases can occur.
Not everyone with kidney failure will
Measuring kidney deterioration
Kidney disease usually worsens slowly over a period of
years. There are five stages of kidney deterioration, each
requiring different tests and treatments, said Associate
Professor Lina Choong, Senior Consultant and Director of
Dialysis, Department of Renal Medicine, SGH.
develop overactive parathyroid glands;
an estimated one-third of kidney failure patients develop the condition
eventually. While the overactive glands
can be controlled through medication
and diet, about 5 per cent to 15 per
cent of patients will need to turn to
surgery as a last resort to address
the problem.
The stages are defined based on the glomerular filtration
rate (GFR), the best measure of kidney function. The GFR
is calculated using the results of a blood test along with
the patient’s age, race and gender. The higher the GFR, the
better the kidney’s function.
Stage I
Stage II
Stage III
Stage IV
Stage V
(end-stage)
GFR
> 90
GFR
60 – 89
GFR
30 – 59
GFR
15 – 29
GFR
< 15
PhotoS: alvinn lim
all food has some phosphate in it,” said
Associate Professor Lina Choong, Senior
Consultant and Director of Dialysis,
Department of Renal Medicine, SGH.
For people with kidneys that function normally, this excess phosphate
is excreted through the urine, and balance is regained quickly. But when the
kidney is not functioning normally, as
Dr Jeremy Ng (foreground) uses
an ultrasound scan to check Mr Ho
Peng Fun’s parathyroid glands. Mr
Ho underwent surgery to have his
parathyroid glands removed and the
gland function restored by the injection
method. The 65-year-old had bone
pain, a common symptom of overactive
glands in kidney failure patients.
(dialysis or kidney
transplant needed)
GFR 10090 80 7060 5040 3020 10
0
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