*This is excerpted from an original article at Johns Hopkins Medicine. Click here to be taken to the original article.
Neck Surgery's Scarless Alternative
In spring 2015, Gwen couldn’t get rid of her lingering sore throat. “I didn’t feel right. I didn’t feel like my normal self,” she recalls.
Over the next few months, she made several visits to her doctor and an otolaryngologist (ENT) — a doctor who specializes in treating the ear, nose and throat. Their diagnosis suggested that she had acid reflux, and Gwen received medication for the condition.
A few more months passed. Gwen developed a small, visible lump in her neck, and her sore throat persisted. Her concerns rose. She returned to her ENT and was diagnosed with a thyroid nodule. A thyroidectomy (the surgical removal of the thyroid gland) was recommended, and she was referred to a head and neck endocrine surgeon.
Meeting the Surgeon
More than a year after her initial sore throat, Gwen met with head and neck surgeon Jonathon Russell, at Johns Hopkins to discuss the thyroidectomy. When she explained her symptoms, such as low bone density, fatigue and kidney stones, Russell ordered additional tests. “Her symptoms were not consistent with that I would have expected,” he recalls. The test revealed abnormally high calcium, vitamin D and parathyroid hormone levels in her blood.
Misdiagnosis Revealed
Russell formally diagnosed Gwen with hyperparathyroidism caused by a parathyroid nodule. These nodules can cause the parathyroid gland to incorrectly regulate calcium levels in the body, leading to kidney stones, depression and lack of energy — all symptoms Gwen had been experiencing for over a year. The symptoms had progressed slowly enough that Gwen had attributed them to age and lifestyle. “That didn’t make sense in someone her age,” Russell recalls.
He referred Gwen to an endocrinologist, who confirmed the diagnosis. Taking the additional steps and not accepting Gwen’s diagnosis at face value prevented an unnecessary thyroidectomy, which would not have fixed the real problem — the enlarged and overactive parathyroid gland.
A Scarless Surgical Treatment
Russell discussed treatment options for Gwen’s parathyroid nodule, which would need to be removed surgically. Among the surgical options, Russell felt Gwen would be a great candidate for transoral neck surgery (TONS), which would not leave a scar like traditional neck surgeries. During this scarless procedure, Russell would make an incision inside Gwen’s mouth and remove the affected parathyroid gland.
In part because of no scarring after the surgery, Gwen elected to have TONS, the scarless surgery.
The night before the surgery, Gwen received a call from Johns Hopkins. To her surprise, it was Russell, who called to answer any final questions she might have regarding the surgery. He explained the procedure again and advised Gwen on what to expect after surgery. “I was very impressed that he called. It reassured me that he was dedicated to his work and cared about his patient,” Gwen reflects.
Last-Minute Concerns
The next morning, Gwen prepared for surgery but began to feel uneasy again while she waited with her mother in the surgical prep room. She worried that the nodule could be cancerous, like a former doctor had suggested. Russell greeted Gwen and her mother. Sensing her anxiety, he sat next to Gwen, placed her hand in his, and discussed her diagnosis and the procedure once more. “He was very reassuring and helped me to relax,” Gwen says.
Following surgery, Gwen wore a compression dressing around her neck and lower jaw designed to ease swelling and discomfort, which was minimal. Her surgery was an outpatient procedure, but she took two weeks off from work to recover and rest her voice. She only needed medication prescribed for the pain for a couple of days. “After that, I only took acetaminophen for a few more days and ate ice cream,” she recalls. Gwen also experienced a little numbness in her chin, which subsided quickly.
Before returning to work, she visited her dentist for a routine cleaning. The incision in her mouth was barely visible just two weeks after surgery. “My dentist was amazed!” she remembers.
Life After Surgery
Five months after surgery, Gwen is enjoying life. “I feel great! The depression and mood swings that the parathyroid nodule caused are now gone, and my calcium levels are back to normal,” she says. Gwen’s back to living a life free of pain, which allows her to do the things she enjoys, such as gardening, shopping and exercising.
“Dr. Russell has been a godsend to me. He was the one who discovered that I had a parathyroid nodule and not a thyroid nodule, and this made all the difference in the world,” Gwen says. “Because of him, the proper medical procedure was performed, and I do not have an unsightly scar on my neck.”