In primary hyperparathyroidism, increased secretion of PTH occurs because one or more of the glands have become enlarged and overactive. The disease is most common in people over 60, but can also be seen in younger adults. Women are more likely to be affected than men. Radiation to the head and neck increases risk. Hyperparathyroidism in childhood is distinctly unusual.
Secondary hyperparathyroidism is a consequence of kidney failure. All four glands Increase their activity and secrete more parathyroid hormone due to absence of important chemicals from the kidney that help balance the body’s calcium level. Over time the parathyroid glands start to work independently without being control by the level of calcium in the blood (this is called Tertiary Hyperparthyroidism). The PTH levels continually rise and cause the fore-mentioned problems.
Parathyroidectomy is the surgery to remove one or all parathyroid glands. Our team of expert surgeons utilizes the technique of minimally invasive parathyroidectomy via a small incision as well as intraoperative PTH hormonal assay to ensure a more effective and less invasive procedure. As a result, our patients’ recovery course is much simpler.
Parathyroid cancer is very rare, and most parathyroid tumors are benign. Less than 0.1% of people with hyperparathyroidism are diagnosed with a malignant parathyroid tumor.
The effects of increased calcium are seen in several body systems including the skeletal (osteoporosis, bone pain, and fractures), gastrointestinal (ulcers), renal (kidney stones), and central nervous system (patient complain of feeling “foggy”, inability to concentrate, frequent headaches, depression, and mood swings). Other symptoms include fatigue, forgetfulness, high blood pressure, poor sleep, heart palpitations and more. The severity of symptoms does not correlate to the level of increase in calcium. Some patients with minimally elevated calcium will suffer from severe osteoporosis. Often patients’ symptoms are not appropriately diagnosed as relating to a parathyroid disorder, and the patients go untreated. Most patients have a few of these symptoms at the same time, but even the patients who are without symptoms find that they feel much better after surgery. In several medical studies it has been shown that 95% of patients state they feel better after surgery. Most patients feel an immediate improvement in many of the symptoms as soon as 72 hours after surgery. All patients with hyperparathyroidism will develop osteoporosis. Taking Fosamax or Actonel will not help bones that are less dense due to parathyroid disease. Prolonged increase in calcium is very hard on the body and has been proven to correlate with a decreased life expectancy. Parathyroid disease will get worse with time in all patients. It will not stay the same, nor will it get better on its own.
The diagnosis is made often by keen clinicians who note the presence of a combination of signs and symptoms. But most often the diagnosis is made by laboratory tests that show a persistent increase in blood calcium levels. This is usually followed by checking the level of parathyroid hormone PTH; an elevated PTH level confirms hyperparathyroidism. However, there are times when the calcium stays elevated without a significant elevation in PTH. A fluctuating blood calcium level that occasionally is in the normal range is a frequent occurrence in patients with parathyroid disease.
The sestamibi scan is the preferred way to localize the abnormal parathyroid gland (Figure 3). The marker used for this scan preferentially is absorbed by the active, diseased parathyroid gland. This is a very sensitive test that needs to be done by imaging centers with expertise to get accurate results. We often times get a CT scan of the neck at the same time to further study the anatomic location of the diseased gland. |
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There are no drugs that will make parathyroid disease better. The only successful treatment for parathyroid disease (hyperparathyroidism) is surgery. Parathyroidectomy is the surgery to remove one or all parathyroid glands. The traditional surgical approach involved a large incision and exploration of both sides of the neck. Our team of expert surgeons utilizes the technique of minimally invasive parathyroidectomy via a small incision as well as intra-operative PTH hormonal assay to ensure a more effective and less invasive procedure. As a result, our patients’ hospital recovery course is much simpler.
In primary hyperparathyroidism a great majority of cases are caused by an abnormality (increased activity) in one single gland (parathyroid adenoma), that causes the remaining three glands to become dormant. A parathyroid scan (Sestamibi scan) can often times localize this one gland, allowing us to take a minimally invasive approach to this disease and removing this one gland (Figure 4). In our center, we combine the Sestamibi scan with a CT scan of the neck to improve the localization of the parathyroid adenoma. |
