What is Parathyroid Disease?
Most people have four parathyroid glands that are usually located next to the thyroid gland in the center of the neck. However, a few people have less or more than four parathyroid glands and sometimes they can be located in different areas in the neck or in the chest. The parathyroid glands secrete parathyroid hormone (PTH) which helps maintain normal blood calcium. When blood calcium is low, the parathyroid glands release PTH to get the calcium back to normal. Blood calcium is maintained by the kidneys, bones and intestines. Most people with hyperparathyroidism have no symptoms. It is often detected by blood work done for other reasons. Symptoms of elevated calcium are non-specific and include joint aches, fatigue, weakness, mild depression and difficulty concentrating. Sometimes people will have low bone density or kidney stones.
To diagnose hyperparathyroidism, blood work will be obtained looking at blood calcium levels, parathyroid hormone levels and sometimes Vitamin D levels. If hyperparathyroidism is found, some patients may be recommended to have a bone density test to look if the bones have become weaker. An ultrasound of the neck is often ordered to see if there are enlarged parathyroid glands. A sestamibi scan may be ordered to identify if only one gland is hyperactive.
There are three different types of hyperparathyroidism: primary, secondary or tertiary. Primary hyperparathyroidism is when one or more parathyroid glands become overactive and secrete excess parathyroid hormone which causes blood calcium to be high. The most common cause is due to a single gland being overactive. Sometimes all four glands can be overactive. This is called hyperplasia. Secondary hyperparathyroidism is caused due to calcium not being absorbed correctly which is most commonly due to kidney failure. Tertiary hyperparathyroidism is when the parathyroid glands act independently and continue to secrete excess parathyroid hormone after secondary hyperparathyroidism has been corrected.
Non-surgical treatment may be offered for patients with mild elevation of calcium and have no symptoms. Blood work will be monitored about every 6 months. People with hyperparathyroidism should avoid lithium, thiazide diuretics (used to treat high blood pressure) and excess calcium.
How Can We Help?
Surgery is indicated for people with moderately elevated calcium. An incision is made in the lower neck. In the case of a single gland being overactive, then that gland is removed. We measure the parathyroid hormone after removal of the gland in the operating room. If the PTH level returns to normal, then you will be woken up from surgery. If the level remains high, then we continue to explore for additional overactive glands. If all four parathyroid glands are overactive, then we will remove 3 ½ glands. Some people go home the same day of surgery and other patients stay overnight.
Who to Contact
Dr. Charlie Jones and Dr. Susan Hagen are general, vascular and thoracic surgeons with over 30 years of experience. To make an appointment, please call 303-443-2123.