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MON–FRI 8:00–17:00 CT For referring physicians

Parathyroid · Thyroid · Adrenal — Houston, Texas

The Glands are Small,
The Stakes are High.

A healthy parathyroid gland weighs about forty milligrams and sits beside the nerve that carries your voice. Endocrine surgery is the delicate discipline of finding the diseased gland(s), removing them, and leaving everything else exactly as it was. It's all that we do at this center of excellence.

Request a consultation Call 832-957-6500
Portrait of Dr. James W. Suliburk

James W. Suliburk, MD, FACSProfessor & Chief of Endocrine Surgery, Baylor College of Medicine

  • Parathyroid gland ≈ 40 mg
  • Thyroid gland 15–25 g
  • Adrenal gland 4–6 g
  • Recurrent laryngeal nerve 1–2 mm

Experience

Thousands Endocrine operations performed to date
Hundreds Parathyroid, thyroid and adrenal cases per year
95% Cure rate for first-time parathyroid surgery
> 18 Years in practice as a fellowship-trained endocrine surgeon

Cure rate refers to first-time parathyroid surgery in appropriately selected patients. Outcomes depend on the individual diagnosis and vary between patients; no result is guaranteed.

Center of Excellence 01

SUPERIOR PARATHYROID SUPERIOR PARATHYROID INFERIOR PARATHYROID INFERIOR PARATHYROID TRACHEA

Four glands · 5 × 3 × 1 mm each
Normal weight 30–50 mg

Parathyroid Center of ExcellenceHigh calcium is not a lab error.

Most Primary hyperparathyroidism is caused by a single benign tumor on one of four glands. It is the reason for the kidney stones, the thinning bones, the fatigue and the fog — and it is cured by an operation that removes a growth the size of a raisin or grape and takes well under an hour.

A scan does not make the diagnosis. Biochemistry does. A negative sestamibi is a reason to operate with an experienced surgeon — not a reason to wait or observe.

SURGERY IS THE ONLY CURE FOR PRIMARY HYPERPARATHYROIDISM

Conditions treated

  • Classic Primary hyperparathyroidism
  • Persistently elevated serum calcium
  • Normocalcemic or Normohormonal  hyperparathyroidism
  • Recurrent kidney stones and osteoporosis from parathyroid disease
  • Secondary and tertiary hyperparathyroidism in kidney failure and transplant
  • MEN1, MEN2A and familial hyperparathyroidism
  • Persistent or recurrent disease after a failed prior neck operation

Operations offered

  • Focused (minimally invasive) parathyroidectomy
  • Bilateral neck evaluation with four-gland assessment
  • Intraoperative PTH and Nerve monitoring
  • Subtotal and total parathyroidectomy with autotransplantation
  • Reoperative parathyroid surgery for persistent disease
  • Mediastinal and ectopic gland exploration
  • Image-guided localization

Center of Excellence 02

THYROID NODULE RECURRENT LARYNGEAL N. TRACHEA

Nodules found in roughly half of adults
About 1 in 20 proves to be cancer

Thyroid Center of ExcellenceThyroid Nodules Occur Frequently. 

The work is knowing which are dangerous.

Thyroid nodules are extremely common and the overwhelming majority are benign. The decision that matters is which ones need an ultrasound-guided biopsy, which need molecular testing, which can simply be watched, and which need an intervention — and how much of the gland has to come out when it does.  We custom develop treatment plans specific to your disease process and your goals of care.  We make every effort to preserve as much non-diseased native thyroid as possible.

Voice and calcium are not complications to be managed afterwards. They are things to be protected during the operation, deliberately, every time.

Conditions treated

  • Thyroid nodules and multinodular goiter
  • Large and substernal goiter causing pressure, cough or difficulty swallowing
  • Papillary, follicular, Hürthle cell, and medullary thyroid cancer
  • Graves' disease and toxic nodular hyperthyroidism
  • Hashimoto's thyroiditis with compressive symptoms
  • Indeterminate biopsies (Bethesda III and IV)
  • Recurrent thyroid cancer and prior incomplete surgery

Operations & procedures

  • Thyroid lobectomy and total thyroidectomy
  • Central and lateral compartment neck dissection
  • Radiofrequency ablation of benign and cancerous nodules — no incision, no scar
  • Continuous intraoperative nerve monitoring
  • Parathyroid identification and autotransplantation
  • Office ultrasound and ultrasound-guided fine-needle aspiration

Center of Excellence 03

ADRENAL KIDNEY

4–6 g each · roughly 4 × 2 × 1 cm
Cortex and medulla, four hormone systems

Adrenal Center of ExcellenceA small gland with an outsized reach.

Adrenal tumors are usually discovered by accident on a scan ordered for something else. The question is never only "how big is it" — it is whether the gland is producing a hormone that is quietly driving blood pressure, potassium, weight, bone density or blood sugar in the wrong direction, and whether removing it will reverse that.  

Hypertension or Type 2 Diabetes that will not improve on three medications deserves advanced cortisol and aldosterone testing before adding additional medications.

Conditions treated

  • Adrenal incidentaloma found on CT or MRI
  • Primary aldosteronism (Conn syndrome) with resistant hypertension or low potassium
  • Hypercortisolism, Cushing syndrome and mild autonomous cortisol secretion
  • Pheochromocytoma and paraganglioma
  • Myelolipoma, cysts and large non-functioning masses
  • Hereditary syndromes — VHL, SDHx, MEN2, neurofibromatosis type 1

Operations offered

  • Laparoscopic transabdominal adrenalectomy
  • Posterior retroperitoneoscopic adrenalectomy — back approach, no entry into the abdomen
  • Cortical-sparing (partial) adrenalectomy for bilateral and hereditary disease
  • Open resection for adrenocortical carcinoma
  • Bilateral adrenalectomy for Cushing disease
  • Coordination of adrenal vein sampling and preoperative blockade

Diagnosis before incision

The numbers that decide the operation

Endocrine surgery is a biochemical specialty that happens to use a scalpel. Before any operation is discussed, the diagnosis has to be established in the laboratory. These are the studies that typically settle it. Reference ranges vary between laboratories; interpretation always depends on the whole clinical picture.

Common endocrine workup — typical adult reference values
GlandStudyTypical rangeWhat it points to
ParathyroidSerum calcium8.5 – 10.2 mg/dLHigh calcium with non-suppressed PTH is hyperparathyroidism until proven otherwise
Intact PTH15 – 65 pg/mLA "normal" PTH is inappropriate when calcium is high.
If the calcium is > 10.0 then PTH should be less than 30.
25-OH vitamin D30 – 100 ng/mLDeficiency must be corrected before PTH is interpreted
24-hour urine calcium100 – 300 mg/24 hDistinguishes familial hypocalciuric hypercalcemia
Intraoperative PTH> 50% drop at 10 minConfirms the diseased gland is out during the operation
ThyroidTSH0.4 – 4.0 mIU/LSuppressed TSH redirects a nodule toward a scan rather than a biopsy
Ultrasound (TI-RADS)TR1 – TR5Sets the size threshold and imaging features at which a nodule is biopsied
Fine-needle aspirationBethesda I – VIBethesda III and IV are where molecular testing changes the plan
AdrenalAldosterone : renin ratio> 20 (ng/dL per ng/mL/h)Screens for primary aldosteronism in resistant hypertension
1 mg overnight dexamethasoneCortisol < 1.8 µg/dLFailure to suppress indicates autonomous cortisol production
Plasma free metanephrinesNormetanephrine < 0.9 nmol/LRules out pheochromocytoma before any adrenal operation
CT with washoutAbsolute washout > 60%Characterizes a mass as a benign adenoma

Technique

What is actually done differently

High-volume endocrine surgery is not one surgical procedure. It is a set of specific tools and habits, applied consistently, that shorten the operation, shrink the incision and protect what has to be left behind allowing for optimal healing and a lifetime of improved health outcome

IOPTH

Intraoperative PTH monitoring

Parathyroid hormone has a half-life of a few minutes. Measuring it in the room, before and after removal, confirms the cure while the patient is still asleep rather than at a follow-up visit weeks later.

IONM

Continuous nerve monitoring

The recurrent laryngeal nerve is one to two millimetres across and controls the vocal cord. Continuous monitoring gives real-time feedback on nerve function throughout the dissection, not just at the end.

RFA

Radiofrequency ablation

Selected benign and cancerous nodules can be shrunk in the office with a needle and ultrasound guidance — no incision, no general anaesthetic, no thyroid hormone replacement, and no scar.

TOETVA

Scarless (transoral) surgery

For appropriate candidates, the thyroid or parathyroid is removed entirely through the inside of the lower lip, leaving no visible mark on the neck at all.

TALA

Minimally Invasive adrenalectomy

The adrenal gland is reached from tiny key hole incisions.  Adhesions are avoided, and most patients go home the same or the next day.

REDO

Reoperative neck surgery

Operating in a field that has been operated on before is a different problem from operating in a fresh one. It is planned differently, imaged differently, and belongs with a surgeon who does it often.

Signature

Signature Cosmetic Closure

We use the latest technology in tissue repair, with the state-of-the-art suture material and techniques of plastic and cosmetic reconstructive surgery,for the finest possible cosmetic result.

Portrait of Dr. James W. Suliburk

James W. Suliburk, MD, FACS
Professor & Chief of Endocrine Surgery
Baylor College of Medicine, Houston

Dr. Suliburk operating with surgical loupes and headlight

Endocrine operations are done under magnification and directed light. At this scale, the difference between a good result and a complication is measured in tenths of a millimetre.

About the surgeon

Fellowship-trained. Endocrine only.

Dr. James Suliburk has achieved the pinnacle of surgery as a full tenured Professor of Surgery and Chief of Endocrine Surgery at Baylor College of Medicine in Houston, where he helps to directs the endocrine surgery fellowship and operates exclusively on the thyroid, parathyroid and adrenal glands. He trained in general surgery at the University of Texas Medical School at Houston and completed a prestigious T.S. Reeve endocrine surgery fellowship at Royal North Shore Hospital, University of Sydney — one of the highest-volume endocrine units in the world.

His practice concentrates on operations that reward experience and meticulous attention to detail:

  • Focused parathyroidectomy
  • Open traditional parathyroidectomy
  • Thyroidectomy (lobectomy or total thyroidectomy)
  • Minimally invasive thyroid resection
  • Re-operative neck surgery
  • Minimally invasive or laparoscopic adrenalectomy
  • Percutaneous thyroid nodule and thyroid cancer radiofrequency ablation

Along with being the highest volume surgeon performing endocrine surgery and as a member of the elite Ben Taub emergency surgery team  in the world's largest medical center,  he also teaches these operations to surgical residents, fellows and professional surgeons and is a member of the American College of Surgeons Academy of Master Surgeon Educators.

Medical degreeUniversity of Oklahoma College of Medicine
ResidencyGeneral Surgery — UT Medical School at Houston
FellowshipEndocrine Surgery — Royal North Shore Hospital, University of Sydney
Board certificationAmerican Board of Surgery
American Association of Endocrine Surgeons American Thyroid Association Fellow, American College of SurgeonS ACS Academy of Master Surgeon Educators For referring physicians

Send the labs. We will do the rest.

Referrals are accepted from endocrinology, primary care, nephrology, cardiology and oncology. Patients are seen with a complete surgical plan already formed wherever the workup allows it, so that the first visit is a decision rather than a data-gathering exercise.

  • 01Serum calcium, albumin, intact PTH, 25-OH vitamin D, eGfr and BUN/creatinine for suspected hyperparathyroidism
  • 02TSH, thyroid ultrasound report and any FNA cytology for a thyroid nodule
  • 03Cross-sectional imaging (CT preferred) and a complete hormonal screen for any adrenal mass.  Please contact us if you need help with the hormonal screen.
  • 04Prior operative and pathology reports if there has been previous neck surgery
  • 05Actual images on disc are preferred if possible.

Direct referral line

832-957-6500

Records and imaging may be sent to endocrinesurgery@bcm.edu.

- UrGENT REFERRALS CAN BE SEEN WITHIN 72hrs

- DIRECT PHYSICIAN LINE - 832-724-6382
- SECURE FAX - 713-610-4597

Request a consultation

New patients are seen from across Texas and beyond.

Call to schedule an evaluation, or send records for review before travelling. Self referrals and second opinions are welcome, including for patients who have already been told an operation is or is not necessary.  In most cases visits can be performed via convenient and secure telehealth to prevent the need for long distance travel for evaluation.

832-957-6500

Monday – Friday · 8:00 – 17:00 Central

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Clinic Baylor St. Luke's Medical Center Dan L Duncan Comprehensive Cancer Center 1919 Old Spanish Trail 6th Floor — Surgical Oncology Houston, Texas 77054 View on Google Maps
Telephone 832-957-6500
Email endocrinesurgery@bcm.edu
Affiliation Baylor College of Medicine · Baylor St. Luke's Medical Center · Harris Health System
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