There are four parathyroid glands in the neck which are roughly the size of peas. They are found on the thyroid gland within the neck and are named similarly; however, they have very different purposes. The parathyroid glands produce parathyroid hormone (PTH), which aids in your body’s ability to keep a proper balance of phosphorus and calcium. This article discusses hyperparathyroidism causes and treatment.
What is primary hyperparathyroidism?
Primary hyperparathyroidism originates within your parathyroid glands. In this disorder one or more parathyroid gland produces too much PTH. This can result in a reduction or an imbalance of calcium and/or phosphorus.
The most common cause of primary hyperparathyroidism is a sporadic, single parathyroid adenoma (95%). Less commonly four gland parathyroid gland hyperplasia is the cause (3%), adenomas in more than one gland (2%) and parathyroid carcinoma (malignant tumour, 0.005%).
Primary hyperparathyroidism is also a feature of several familial endocrine disorders: Multiple endocrine neoplasia type 1 and type 2A (MEN type 1 and MEN type 2A), and familial hyperparathyroidism.
What is reactive hyperparathyroidism?
Reactive hyperparathyroidism may occur when other problems including kidney failure cause your parathyroid glands to become overactive.
The effects of high PTH
High PTH levels will signal your bones that they need to release more calcium into the bloodstream. This causes your blood calcium levels to become higher than normal. In addition the bones may become weakened after they lose calcium.
The small intestine can also absorb too much calcium from foods, which adds to the blood calcium levels. The kidneys may excrete more calcium in urine, when they respond to the higher than usual blood calcium levels. This may lead to the formation of kidney stones.
According to the U.S. National Library of Medicine, high levels of blood calcium may contribute to other medical issues as well, including high blood pressure, heart disease and difficulty in concentrating. Medline Plus states that more research is still needed in order to understand fully how primary hyperparathyroidism creates problems for the central nervous system and cardiovascular system.
Why is calcium so important?
Calcium is an essential element for good health. It plays an integral role in the development of bones and teeth. When it is combined with phosphorus, it strengthens the bones and the teeth. Calcium also aids in muscle contractions and the transmission of nerve signals.
What are the treatment methods for hyperparathyroidism?
The only definitive treatment for this disorder is the surgical removal of the parathyroid gland that has become overactive. If patients have no symptoms, specialists use guidelines to determine whether surgery is indicated. This surgery, when performed by licensed and experienced surgeons, is successful over 95% of the time.
Your surgeon may also utilise imaging tests before he or she performs surgery, to locate the gland that is overactive, and target it for removal.
Surgeons may use one of two main strategies for removal of the overactive gland.
The first is a parathyroidectomy, which is minimally invasive. This can be done as an outpatient, and is utilised when only one gland is thought to be overactive. Your surgeon will be guided by tumour imaging tests, and will make a small incision (around 3cm) in your neck, and then remove the overactive parathyroid gland. The small size of this incision means that you will usually experience less pain and have a faster recovery than those who have surgery that is more invasive. The surgeon may use a general or local anaesthesia.
The other type of surgery used in removing the parathyroid is a standard open parathyroid gland exploration. This uses a larger incision (around 6cm) that will allow your surgeon to access and then examine all four of the parathyroid glands. Then the overactive gland(s) will be removed. This is a more extensive surgery and generally requires a one to two day stay in hospital.
If you have questions or concerns about hyperpararthyroidism contact your local doctor, who will arrange for you to see a thyroid surgeon.
