Parathyroid conditions

Introduction

Parathyroid glands are located behind the thyroid gland and control the amount of calcium in our blood and bones. About 1 in 100 people (1 in 50 women over 50) develop a parathyroid gland tumour during their lifetime causing parathyroid disease called "hyperparathyroidism". Hyperparathyroidism is a destructive disease that causes high blood calcium – which leads to serious health problems – even early death. It can be cured in most patients in less than 20 minutes by surgically removing the parathyroid tumour. Hyperparathyroidism is not just an abnormal high blood calcium that can be monitored by your doctors. Bad things will always occur and thus the parathyroid tumour should be removed in virtually all cases.

Causes

The most common cause of excess hormone production (hyperparathyroidism) is the development of a benign tumor in one of the parathyroid glands. This enlargement of one parathyroid gland is called a parathyroid adenoma, which accounts for about 70 percent of all patients with primary hyperparathyroidism (the other 30% will have more than one bad gland, see chart below). This out of control parathyroid gland is essentially never cancerous (virtually 100% of them are benign tumors), however, it slowly causes damage to the body because it induces an abnormally high level of calcium in the blood, which can slowly destroy a number of tissues. Parathyroid adenomas typically are much bigger than the normal "grain-of-rice" parathyroid and will frequently be about the size of an olive or grape. Thus, the typical patient with hyperparathyroidism will be cured of the disease when this "olive" size tumor is removed. Up to 30% will have more than one tumor, so your surgeon should test to make sure the others are all normal.

Symptoms

Since parathyroid gland disease (hyperparathyroidism) was first described in 1925, the symptoms have become known as "moans, groans, stones, and bones...with psychic overtones". 

Nearly all patients with parathyroid problems have symptoms. Sometimes the symptoms are really obvious, like kidney stones, frequent headaches, fatigue, and depression. Sometimes the symptoms are not so obvious, like high blood pressure and the inability to concentrate. If you have symptoms, you are almost guaranteed to feel remarkably better once the parathyroid tumour has been removed. As we often tell our patients: "you will be amazed at how a 16-minute mini-procedure will change your life!"

Hyperparathyroidism can show up differently in different people. Sometimes it makes people miserable within the first year or two of having high blood calcium. Other times it can go 6-8 years without causing too many problems other than fatigue, bad memory, kidney stones, and osteoporosis, acid reflux, high blood pressure, cardiac symptoms and headaches. Hyperparathyroidism is a simple benign disease that will slowly affect your body. The good news is that hyperparathyroidism is typically very easy to cure.

Tests

The best way to diagnose primary hyperparathyroidism (disease of the parathyroid glands) is by showing an elevated parathyroid hormone level at the same time you have elevated serum calcium. Measuring the amount of calcium in the urine over a 24-hour is sometimes required to confirm the diagnosis and to rule out other congenital causes of hypercalcaemia. An ultrasound of the neck, nuclear medicine parathyroid scan and a 4D neck CT scan may also be required.