Hyperparathyroidism

Overview

Parathyroid Glands

The parathyroid glands are four small glands located in the neck that are responsible for controlling the calcium level in our blood. Despite the name similarity, the thyroid and parathyroid glands are not the same and serve very different functions. Problems with the parathyroid glands do not translate into problems with the thyroid gland which is under a different type of control.

The most common problem affecting the parathyroid glands is hyperparathyroidism (HPT), when one or more of the glands become too active and no longer follow the normal body signals to shut down the production of parathyroid hormone. As a result, the calcium level in the blood will rise and can affect many of the internal organs such as bones, muscles, kidneys, gastrointestinal tract, and even memory and mood.

Causes

Hyperparathyroidism or elevated parathyroid hormone is most often caused when one gland is enlarged because of a noncancerous growth (adenoma). In the minority of cases, more than one gland can be diseased. Parathyroid cancer is very rare and accounts for only 1% of hyperparathyroid cases. Hyperparathyroidism is a very treatable problem and surgical removal of the abnormal gland or glands is the only curative treatment.

The diagnosis of hyperparathyroidism is often made by a blood test that examines your blood for calcium, parathyroid hormone, and vitamin D levels. In addition, once the diagnosis is made, your doctor may choose to do additional studies to determine whether some of your most commonly affected organs have been involved. This may include a urine sample to test whether there has been any damage to the kidneys. Along the same lines, a bone density study can show whether having had hyperparathyroidism has affected your bone health. The bony areas most often tested are hips, lower back, and forearm.

Symptoms

It is common for patients with hyperparathyroidism not to know that they are affected. This is because the signs are usually very mild and vague. Patients often attribute these symptoms to other health reasons or life stressors. Some patients may experience the following:

  • Depression
  • Difficulty concentrating
  • Forgetfulness
  • Constipation
  • Abdominal pain
  • Excessive thirst
  • Excessive urination
  • Kidney stones
  • Joint or bone pain
  • Muscle weakness
  • Bone loss
  • Broken bone

Treatments

Surgery is the only cure for primary hyperparathyroidism. The vast majority of our patients are candidates for minimally invasive or focused parathyroidectomy. This process is initiated by localizing the abnormal gland with specialized imaging by one of our dedicated endocrine radiologists. Once this is accomplished, a focused exploration of the neck through a less than one-inch incision is performed and the abnormal gland is removed. This often eliminates the need for a more extensive surgery involving exploration of both sides of the neck. In addition, this technique offers a more aesthetic incision, a shorter operating time and a lower incidence of postoperative hypocalcemia. The procedure is most often performed with a combination of local and general anesthetic to optimize patient comfort and safety. In appropriately selected patients, minimally invasive parathyroidectomy can often be performed as an outpatient.