The parathyroid glands produce parathyroid hormone (PTH). This hormone interacts with calcium, phosphorus, and vitamin D levels in the blood and bone. There are most likely four parathyroid glands (each about the size of a grain of rice) located in your neck. Some patients have more than four, and others less. The glands can become overactive and produce too much parathyroid hormone into the bloodstream
There are three types of hyperparathyroidism. In primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes overproduction of the hormone, resulting in high levels of calcium in the blood (hypercalcemia), which can cause a variety of health problems. Surgery is the most common treatment for primary hyperparathyroidism.
Secondary hyperparathyroidism occurs as a result of another disease that initially causes low levels of calcium in the body. The parathyroid glands produce more PTH in response and calcium is taken from the bone and reabsorbed by the intestines and kidney. Tertiary hyperparathyroidism is an uncommon condition that can be present in patients who have undergone kidney transplant. In most situations, surgery is not required for either secondary or tertiary hyperparathyroidism.
Hyperparathyroidism is diagnosed with a blood test measuring the amount of parathyroid hormone.
After a diagnosis of hyperparathyroidism, your doctor will likely order additional tests to rule out possible secondary causes and assess complications
Bone mineral density test (bone densitometry). The most common test to measure bone mineral density is dual energy X-ray absorptiometry, or a DEXA scan. This scan measures levels of calcium and other bone minerals.
Urine tests. A 24-hour collection of urine can provide information on how well your kidneys function and how much calcium is excreted in your urine. If a very low level of calcium in the urine is found, this may indicate a condition that doesn't require surgical treatment.
Imaging tests of kidneys. Your doctor may order X-rays or other imaging tests of your abdomen to determine if you have kidney stones or other kidney abnormalities.
If your doctor recommends surgery, imaging tests can locate the parathyroid gland or glands that are causing problems:
Sestamibi parathyroid scan. Sestamibi is a safe radioactive compound that is absorbed by overactive parathyroid glands which can then be "seen" by a scanner.
4D Computerized tomography (CT) scanning may be combined with the scan to improve detection of an abnormality.
Ultrasound. Ultrasound uses sound waves to create images of your parathyroid glands and surrounding tissue.
If calcium levels, kidney function and bone densities are relatively normal then scheduling regular tests and monitoring may be a better option than surgical treatment. Your doctor may recommend a watch-and-wait approach or evaluation by an Endocrinologist.
Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in about 95 percent of all cases. A surgeon will remove only those glands that are enlarged or have a tumor (adenoma).
If all four glands are affected, the surgeon will likely remove only three glands and perhaps a portion of the fourth - leaving some functioning parathyroid tissue.
Surgery may be done as an outpatient procedure, allowing you to go home the same day. In such cases, the surgery can be done through very small incisions in the neck. Complications from this surgical procedure are rare.
Medications to treat hyperparathyroidism include calcimimetics which mimic calcium circulating in the blood and trick the parathyroid glands into releasing less parathyroid hormone.
For women who have gone through menopause and have signs of osteoporosis, hormone replacement therapy may help bones retain calcium. This treatment doesn't address the underlying problems with the parathyroid glands.
Prolonged use of hormone replacement therapy can increase the risk of blood clots and breast cancer. Work with your doctor to evaluate the risks and benefits to help you decide what's best for you.
Bisphosphonates also prevent the loss of calcium from bones and may lessen osteoporosis caused by hyperparathyroidism. Medical interventions for parathyroid disorders are often carried out by an Endocrinologist.
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