Garry Shandling and the Disease You Didn’t Know About

James Fallows, national correspondent for The Atlantic, recently wrote about the death of comedian Garry Shandling, noting that he suffered from hyperparathyroidism, a condition that, if left untreated, can raise the risk of having a heart attack and other serious medical conditions. Fallows' piece was both personal and educational, laying out the hazards of delaying treatment, as he himself did by putting off surgery for many years. Fallows ultimately consulted with Quan-Yang Duh M.D. (pictured right) at UCSF Endocrine Surgery and Oncology about his condition. Excerpts from the Atlantic story and related comments appear below. 

Unlike most people writing reflections on the late Garry Shandling, I had no personal or professional connection to him. Of course I thought he was funny, in a pioneering cringe-inducing way. And like many people I am of course sorry that he has died.

But here is why I am stepping outside my normal realm of discourse to say something more in the wake of his death. In his wonderful and touching “Comedians in Cars Getting Coffee” segment with Jerry Seinfeld, filmed not long before his death, Shandling mentions that he’s been diagnosed with an obscure disorder called hyperparathyroidism. He makes it a joke: “The symptoms are so much like being an older Jewish man, no one noticed!” But I noticed this mention, and I think it’s worth broader attention.

Fallows then provides an excellent lay summary of hyperparathyroidism.

The parathyroid (PT) glands, as I have come to know, have nothing to do with the much more famous thyroid gland. Most people have four of them, usually located in the neck; they are very small, and they regulate the level of calcium in the blood. For most healthy people, the blood-calcium level is confined within a narrow range. If your reading goes above that range, it likely means that something has gone wrong with one of your PT glands, usually because of a noncancerous tumor called an adenoma. If that is so, it likely means that you won’t get better until the gland is surgically removed. As long as it is there, it will keep pumping out hormones that direct your body to keep raising the blood-calcium level, even though that is already too high. Usually just one of the glands has developed a disorder, and usually people can get along fine after having one, two, or even three of the four PT glands removed. But until the bad one is taken out, your health is going to get worse and worse and worse. One of the ways it might deteriorate is through a premature tendency to heart attacks—and a heart attack appears to have been what felled Garry Shandling at age 66.

Fallows discusses why he decided to postpone surgery, partially out of ignorance about the disease.

I’d postponed getting the surgery as long as possible, for a variety of reasons. I avoid surgery in general, and apart from a childhood tonsillectomy had never been operated on. I was in the middle of an engrossing China assignment and didn’t want to break it up. I knew that the cutting-and-probing of PT surgery takes place around the larynx, the vocal cords, and all related nerves, and thus carried a minor but real risk of permanent voice damage. And—the main point—since I’d never heard of this disease (and had barely heard of the parathyroids), I didn’t take the situation seriously.

Fallows ultimately consulted with Quan-Yang Duh M.D. at UCSF where he learned about the serious risks of untreated hyperparathyroidism.

When I met Dr. Duh in San Francisco to discuss whether I actually needed the operation, he told me that in overall toll on well-being, a parathyroid disorder was about as damaging as smoking a pack of cigarettes per day. It weakened the bones; it raised the risk of heart attacks and some cancers, and kidney stones too; it caused mood disorders; and—I’ll confess the most alarming—it led to memory lapses, attention failures, and dementia. The bone-weakening is because the hyperactive gland continually draws calcium out of the bones and into the blood serum.

And his final thoughts on the surgery.

If I had known ten years ago what I know now, I would have had the surgery as soon as the diagnosis was confirmed.

In the comment section following the article, The Parathyroid Papers: Garry Shandling and a Little-Known Disease, Fallows provides advice on how to chose a hospital and surgeon. (The procedure to remove one for more of the parathyroid glands is a called a parathyroidectomy).

As with any complex procedure, it makes sense to choose a facility and doctor that perform the operations frequently rather than rarely. When we were asking around, eight years ago, the UCSF hospital and Dr. Quan Duh came highly recommended on those grounds (and I have since heard from other patients grateful for his treatment there).