Your body has four parathyroid glands located in the neck generally behind the thyroid gland. These glands are about the size of a grain of rice. The parathyroid glands produce parathyroid hormone (PTH), which is responsible for controlling calcium metabolism. These glands maintain proper levels of both calcium and phosphorous in your body by turning the production of PTH off or on. Most of the time, this balancing act works well. But sometimes one or more glands produce too much PTH leading to abnormally high levels of calcium and low levels of phosphorous in your blood.
Hyperparathyroidism may occur because of a problem with the parathyroid glands themselves (Primary Hyperparathyroidism) or because of another disease that affects the glands’ function (Secondary Hyperparathyroidism). Hyperparathyroidism leads to increased levels of PTH, which causes absorption of calcium from bone resulting in weak bones. The resulting elevation of calcium in the bloodstream leads to elevated levels of calcium in the urine and can cause kidney stones. Patients can also experience depression, muscle weakness, and fatigue. Usually patients are referred to us with primary hyperparathyroidism:
- A noncancerous growth (adenoma) on a gland – the most common cause
- Enlargement (hyperplasia) of several of the parathyroid glands
- A cancerous tumor – very rare cause
Patients are usually referred to us with elevated blood calcium levels as well an elevated PTH level. Your surgeon will ask you about your symptoms and perform a physical exam. Your evaluation may include additional blood and urine tests. If your surgeon recommends surgery, he or she will likely use an imaging test to locate the parathyroid gland or glands that are causing problems. A Sestamibi parathyroid scan, ultrasound, or CT scan may be used to identify the abnormal gland(s).
Surgery is the most common treatment for primary hyperparathyroidism and achieves a cure 95% of the time. Your surgeon will remove only those parathyroid glands that are enlarged or have a tumor (adenoma). Surgery can be done as an outpatient procedure and usually through a small incision in the neck for an adenoma. If all four glands are affected, your surgeon will likely remove only three glands and perhaps a portion of the fourth – leaving some parathyroid tissue. Most patients are observed overnight with this type of procedure. Complications from surgery are not common. Some people experience mild hoarseness temporarily if multiple glands are explored. Permanent hoarseness caused by damage to the voice box nerves because of their close location to the parathyroid glands is very rare (<1%). Low calcium levels may occur for a few days and are treated with calcium supplements by mouth. Long-term low calcium levels requiring treatment is rare. Infection and bleeding is also rare. Despite advances in surgery and imaging, about 1% patients will have on-going hyperparathyroidism after surgery because we are unable to locate the affected gland (usually due to abnormal location of the gland).