Canadian patient receives groundbreaking treatment for a disabling disorder, with a parathyroid transplant into her arm
Canadian doctors say they have cured a patient with a severe and disabling disorder with a parathyroid transplant from a deceased donor.
Dawn Ethier, a mother of four and police officer in Ottawa, is the first in North America and one of perhaps two in the world given new parathyroid glands that have eliminated her debilitating symptoms.
"I was like, 'Oh my goodness, is this really working? Is this really happening?'" Ethier told CTV News.
The new parathyroid glands sit inside her right forearm where they were implanted by surgeons at Toronto General Hospital in May.
"All four of them are right in here," said the 47-year-old, pointing to a barely visible scar on the inside of her arm.
Her case may mark the start of a new treatment for some patients who have hypoparathyroidism disease, often caused by neck surgery for thyroid disease.
"I think it has the potential to treat a lot of patients who are out there with this debilitating problem," said Dr. Karen Devon, an endocrine surgeon with the Sprott Department of Surgery at the University Health Network in Toronto. This was her first transplant ever, performed with a team at the UHN Ajmera Transplant Centre.
Ethier's medical journey began eight years ago when her thyroid was removed after a diagnosis of cancer. Alongside the thyroid gland are four tiny parathyroid glands that can be damaged by surgery.
Up to 30 per cent of patients who undergo thyroid surgery can develop this condition and in about a quarter of those, it can become permanent. Some estimates suggest that over 100,000 people in North America develop parathyroid disorder each year.
Treatment with parathyroid hormone (PTH) medications and other supplements can help normalize the body's levels of calcium, which the parathyroid usually regulates, but there are few other treatment options if standard therapy doesn't work.
Ethier's condition was severe. She had to take 99 pills and supplements a day to counteract the deficiencies. Even then, she was left with multiple complications, heart problems, blood clots in her lungs, seizures, and temporary paralysis in her hands.
"It seemed like my life completely revolved around hospital visits, monitoring my minerals, making sure that I wasn't symptomatic, it became almost an obsession to make sure that I wasn't going to end up in a medical emergency," she told CTV News.
After eight years of suffering, Ethier admits she sometimes felt hopeless.
"There was no doctor that could tell me how to fix this or what form of treatment had worked in my house. There was just nothing. And every time they had tried something, it didn't work," she said.
Her physician in Ottawa approached Dr. Devon, after Ethier herself researched other possible treatments, finding one successful parathyroid transplant from a living donor in Germany in 2016.
Dr. Devon, who had never performed a transplant, says she was intrigued.
"My first reaction was that it sounds pretty cool. But I hadn't really heard that much about it," said Dr. Devon.
Some patients receive their own parathyroid tissue in the forearm right after thyroid removal surgery. But taking the parathyroids from unrelated deceased donors is far more complex and scientifically uncharted territory.
It took almost two years to devise a plan during the pandemic, and to find Ethier a potential donor. Extensive testing showed that less than two per cent of organ donors would be a match for Ethier according to Dr. Kathryn Tinckam, transplant nephrologist at Ajmera Transplant Centre.
In fact, the first experimental parathyroid transplant in 2021 failed. When a second donor was found another transplant was performed in May 2022.
Four parathyroid glands, about the size of a grain of rice, were taken from a deceased donor. They were implanted in Dawn’s right forearm, in a procedure that took only about 30 minutes.
Within 10 days, Ethier says, her blood tests showed her parathyroid was functioning. Over the past six months, her medication and supplements have been cut down from 99 to 15. The majority of those are now immune-suppressing drugs to prevent her body from rejecting tissue just like with any other organ transplant. These medications carry their own risks, including infection and cancer. But balanced against an improved quality of life, Ethier says there is no comparison.
"I'm actually thriving now," said Ethier. She is back exercising and walking the dog with her husband, Neal.
"After eight years of medical emergency after medical emergency… I have not been in hospital except for follow-ups since the surgery," she said.
She wants her story to lift the spirits of others affected by this little-known yet disabling condition.
"Lots of people suffer with this and just think that there's nothing that can help. And now they have you know something to look forward to," said Ethier.
In fact, doctors at the UHN transplant unit are preparing a study of five more patients to see if parathyroid transplants from unrelated donors are an effective and lasting treatment.
"I think it's really allowed us to show that this is something we can do safely. said Dr. Tinckam, who continues to monitor Ethier.
"As far as ... being a surgeon and being able to really do something innovative, there's no doubt that this is the highlight of my career and that I'm just excited to see where it goes," said Dr. Devon.
This story has been corrected to note that Ethier researched a 2016 parathyroid transplant case involving a living donor in Germany.