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What are parathyroid glands?

Every human body has four parathyroid glands. They are located behind the thyroid gland, with two on each side of the neck. The parathyroid glands regulate the levels of calcium in the blood by producing parathyroid hormone (PTH).

What is hyperparathyroidism?

Hyperparathyroidism is a condition in which these glands produce more PTH than needed. PTH will remove calcium from the bones to send into the bloodstream, so high blood levels of calcium are always present. An excess of calcium in the urine is another sign.

There are two types of hyperparathyroidism. Primary hyperparathyroidism is mostly caused by tumors of the parathyroid glands, so-called adenomas. These tumors are rarely cancerous. Adenomas produce PTH like the parathyroid glands, making the calcium levels in the blood rise. These adenomas don't respond to high blood levels of calcium like the parathyroid glands, but they continue to produce PTH.

Secondary hyperparathyroidism is caused by a nonparathyroid disease which increases the levels of PTH, like kidney failure.

Higher levels of calcium in the blood can occur even if only one parathyroid gland is affected. If all four parathyroid glands are enlarged, it's called parathyroid hyperplasia.

What are the symptoms of hyperparathyroidism?

There may be no symptoms at all, subtle ones, or severe symptoms.

Usually the symptoms of hyperparathyroidism are often nonspecific like weakness, fatigue, pain, aches and depression. In more severe cases a loss of appetite, nausea, vomiting, confusion, constipation, increased urination, increased thirst and even impaired thinking and memory are possible.

Bones are weakened and there is a risk of osteoporosis and fracture. Kidney stones may also develop.

How is hyperparathyroidism diagnosed?

This condition is diagnosed through lab analysis of blood and urine. If these tests show higher blood levels of calcium and PTH, primary hyperparathyroidism is a possibility.

Ultrasounds of the neck or CT scans can identify and locate the enlarged gland.

How is hyperparathyroidism treated?

Hyperparathyroidism treatment depends on the clinical symptoms. If a patient is asymptomatic, the condition can be left untreated. In case of moderate symptoms, medication can manage the situation. For severe symptoms, surgery is needed.

Removing the parathyroid glands is called a parathyroidectomy. This surgery can be approached in a variety of ways.

When only one gland is affected, as in the majority of cases, a minimally invasive parathyroidectomy is performed.

A bilateral neck exploration is the traditional approach. The surgeon would do a medial incision, which makes it possible for them to visually explore all four glands. This procedure is rarely performed today.

A parathyroidectomy is usually performed under general anesthesia. Some possible risks of this are:

  • An allergic reaction to the medicine used for anesthesia
  • Breathing problems after surgery
  • Excessive bleeding
  • Infection
  • Injury to the vocal cords
  • Injury to the thyroid gland

What to expect after surgery?

Patients can normally go back home the same day or the day after the surgery if everything went well.

It is normal to have some pain and discomfort, like a sore throat.

Hypocalcemia will occur, something that is quite normal after surgery. If calcium levels are too low, this is very dangerous. Calcium supplements will go a long way towards preventing this.

Because of hypocalcemia some patients feel numbness or tingling in their fingers and toes.

Calcium blood levels should be monitored for six months after the surgery, but some doctors may require even a year of checkups and calcium supplements.

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