Parathyroid

What is primary hyperparathyroidism?

Primary hyperparathyroidism is a condition in which your blood calcium levels are elevated, usually because of an enlarged parathyroid gland(s). Parathyroid glands control your calcium, like a thermostat controls the temperature in your house. If your house is 90 °F, then the thermostat should turn "off" the heater. If the heater is still "on," then your thermostat is broken.

Similarly, your parathyroid glands control the calcium in your blood. If your serum calcium is high, then your parathyroid glands should be "turned off" (i.e. your parathyroid hormone (PTH) should be low). If your serum calcium is high and your parathyroid glands are making lots of PTH, then one or more parathyroid glands are not working correctly.

What are the symptoms of hyperparathyroidism?

Hyperparathyroidism can cause a host of different symptoms. The most common signs and symptoms we see patients for are weak bones (osteopenia or osteoporosis) or kidney stones. Some symptoms of hyperparathyroidism are more subtle and can include changes in your kidney function, worsening fatigue, short term memory loss, muscle or bone pain, depression, anxiety, abdominal cramps or frequent urination. Very high blood calcium levels can cause seizures and heart problems.

What is a minimally invasive parathyroidectomy?

The phrase "minimally invasive parathyroidectomy" is used to encompass a range of different procedures that strive to minimize the length of the surgical incision; therefore, facilitating a quicker recovery and smaller scar. For decades we made an incision to look at all four parathyroid glands. Nowadays, we use imaging studies (like ultrasound) to focus our operation and remove just the one enlarged parathyroid gland that is causing the problem. This focused, image directed parathyroidectomy is frequently referred to as a minimally invasive parathyroidectomy. Typically, the incision is around 2.5 cm (about 1 inch).

What is parathyroid cancer?

Parathyroid cancer is very rare. Most people with primary hyperparathyroidism have a parathyroid adenoma which is a benign, enlarged parathyroid gland. Patients with parathyroid cancer typically have a very high serum calcium level (greater than 14 mg/dL).

Why do I need to get localizations studies such as an ultrasound, sestamibi scan or CT scan?

Almost all people have four parathyroid glands. Most patients with primary hyperparathyroidism have only one gland that his enlarged and malfunctioning. Localization studies will allow your surgeon to identify which gland is the likely culprit and therefore minimize the extent of surgery to quicken your recovery and improve cosmesis.

My localization studies don't show an enlarged parathyroid adenoma, does that mean I don't have hyperparathyroidism? Can I still have surgery?

The diagnosis of hyperparathyroidism is based on your bloodwork – usually, the finding of elevated serum calcium with an elevated parathyroid hormone (PTH). Localization studies help surgeons determine the type of surgery to perform, but they do not determine if you have hyperparathyroidism. If you have negative localization studies, you can still have surgery, but you may require further imaging or a bilateral (4-gland) exploration to assess all of your parathyroid glands.

What if I had a previous unsuccessful parathyroid surgery?

About 5% of patients will develop persistent or recurrent hyperparathyroidism after a previous parathyroid surgery. Persistent hyperparathyroidism means that your calcium never improved after your previous surgery. Recurrent hyperparathyroidism means that your calcium returned to normal for at least 6 months and then became elevated again. This usually means that you have more than one enlarged parathyroid gland. We are experts in the management of persistent and recurrent hyperparathyroidism and are happy to accept patients with previous failed explorations or recurrent hyperparathyroidism.

Next Steps

Our team at UC Davis Endocrine Surgery is here to help if you are dealing with a parathyroid issue. Please call (916) 734-5959 to set up an appointment with one of our parathyroid specialists.