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Hyperparathyroidism is a condition where there's increased parathyroid hormone levels in the body due to overactivity of one or more of the four parathyroid hormones, which are located behind the thyroid gland.

Primary hyperparathyroidism is caused by an enlargement of one of the four glands and this can result in increased calcium levels in the body.

The complications and problems associated with increased calcium levels in the body include:

  • Increased fragility of bones (osteoporosis) which may result in fractures - this is due to calcium being removed from the bones.
  • Excessive urination.
  • The formation of kidney stones.
  • Developing hypertension (high blood pressure).
  • Becoming easily tired or weak.
  • Abdominal pain.
  • Forgetfulness.
  • Depression.
  • Nausea or vomiting.
  • Loss of appetite.
  • Joint or bone pain.
  • Increased complaints of illness without any obvious cause.
  • If this condition is left untreated during pregnancy, then the newborn may experience severely low levels of calcium.

Management

The most common treatment for primary hyperparathyroidism is by performing a surgery known as a parathyroidectomy. A surgeon will remove the glands which are enlarged or have a tumour, called an adenoma, and this procedure provides a cure in around 95% of all cases of this condition.

If all four of the glands are affected, then a surgeon will remove three of these glands and maybe even a portion of the fourth in order to leaving some functioning parathyroid tissue.

This surgery can be done as an outpatient procedure therefore allowing the patient to go home the same day. In these cases, the surgery may be done through small incisions which are made in the neck using only local anesthetics.

Complications from surgery are uncommon but there are some risks associated with it which may include:

  • Chronic low levels of calcium which will require the use of long-term calcium and vitamin D supplementation.
  • Injury and damage to the nerves which control the function of the vocal cords.

What to research about the surgeon 

A patient's family doctor will, in most cases, advocate for the patient and refer them to a surgeon who would perform a parathyroidectomy.

The family doctor should be able to refer their patients to a surgeon who specializes in thyroid and parathyroid disease prevention. At the very least, the patient should be referred to a surgeon who has successfully performed this procedure before.

In the event that the doctor and patient are situated in a rural area, then referral to the nearest centre with a surgeon who can perform a parathyroidectomy should be considered. Patients who live too far from a larger medical centre may want to consider either being operated on by a surgeon who is located closer to them and can perform the mentioned surgery, or to cover the expenses associated with consulting a surgeon who specializes in parathyroidectomies are is located further away.

Other aspects to look at would be whether the surgeon can perform the procedure on an out-patient basis or whether hospitalization would be needed. This would make the difference between having a local anaesthetic injected, a small procedure done and then being discharged home the same day and being admitted, having an open procedure done under general anaesthesia and spending at least 3 days in hospital to make sure there are no signs of infection.

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