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Parathyroid Disease

Parathyroid glands make parathyroid hormone which controls the levels of calcium and phosphorous in the blood, helps the body make vitamin D.

The parathyroid glands are very small structures that exist just behind the thyroid gland. They serve to regulate the bodies calcium level via parathyroid hormone. Thankfully parathyroid disease is almost always benign. The most common disease of the parathyroid glands are benign growth called adenomas which cause them to secrete excess hormone thereby raising the blood calcium level. Prior to readily available laboratory testing, patients with parathyroid adenomas would become symptomatic from high calcium levels prior to diagnosis. This led to the classic "bones, moans, groans and stones," where patients developed kidney stones, abdominal cramping and pathologic bone fractures. Luckily most patients have semi-routine calcium checks and a parathyroid adenoma is usually picked up prior to the patient becoming symptomatic.

Treatment of a parathyroid adenoma typically involves an imaging localization study known as a sestimibi scan. In a high percentage of cases this will identify the offending gland and will allow minimally invasive surgery for its removal. This is possible due to the measurement of arterial parathyroid hormone which drops quickly once the gland is removed. In rare instances a patient may have a second hyperactive gland and may require removal of this, and in rare instances the thyroid gland as well.

Less common than single adenomas, patients with parathyroid disease will have enlargement of all four of the parathyroid glands. This is known as secondary hyperparathyroidism. The most common reason for this is kidney disease which raises levels of parathyroid hormone directly. A less common cause are certain genetic syndromes known as multiple endocrine neoplasia or MEN. In this scenario all four glands will be removed and a small part of one of these are implanted into the forearm.

Risks of parathyroid surgery are similar to that of thyroid surgery and include low level of calcium due to suppression of the uninvolved glands and in rare instances damage to the nerve that moves the voicebox that resides nearby. As a result most patients are kept overnight to watch for any of these problems.

If you have a thyroid or parathyroid disease and would like to discuss you treatment options, please feel free to give us a call.