PARATHYROID GLANDS
Parathyroid Problems
The Parathyroid Glands
The 4 parathyroid glands are located on the back of the thyroid gland. They are tiny and measure only 3-5 mm or the same size as a grain of rice. They make a hormone called parathyroid hormone (PTH). PTH increases the amount of calcium in your bloodstream by dissolving calcium from your bones, encouraging your kidneys to conserve calcium and helping your bowels to absorb more calcium from your diet.
There are 2 problems that we see associated with your parathyroid glands.
Hyperparathyroidism
Overactivity of the parathyroid glands causes a rise in the calcium level in the bloodstream along with a rise in the PTH level.
What are the symptoms of Hyperparathyroidism
The “classic” symptoms of hyperparathyroidism are:
- Bones - bone pain, pathological fractures
- Stones - kidney stones
- Abdominal moans - constipation, stomach ulcers, pancreatitis
- Psychic groans - loss of appetite, tiredness, confusion, depression, even psychosis
Not everyone will have all of these symptoms and for many patients these days the diagnosis is made by finding a high calcium level on a routine blood test. The main concerns are the longterm effects of Hyperparathyroidism on the bones and the kidneys. Untreated it can cause significant thinning of the bones (osteopaenia) and kidney damage secondary to kidney stones.
Types of Hyperparathyroidism
- Primary hyperparathyroidism is the most common and is caused most often by an enlargement of a single gland known as a parathyroid adenoma. Sometimes all 4 glands become enlarged, called 4 gland hyperplasia. Very rarely a Parathyroid carcinoma may be responsible for a rise in the PTH Level.
- Secondary hyperparathyroidism. Chronic kidney disease may cause excess loss of calcium in the urine and decreased production of vitamin d making the glands work harder and as a result enlarge.
- Tertiary hyperparathyroidism. Correction of the kidney disease (mostly by transplantation) usually results in resolution of parathyroid hyperplasia. In some patients however the parathyroids continue to make excess PTH even in the face of a normal or high serum calcium.
How is Hyperparathroidism Diagnosed?
- Blood Tests. Diagnosis is made by finding raised serum calcium, alkaline phosphatase and PTH on blood tests. Other conditions which may cause high calcium levels include metastatic bone disease, myeloma, Sarcoidosis and PTH secretion by tumours.
- Urine Tests – Urinary Calcium is generally low
- Imaging. It is important to try and find the affected gland or glands as this allows targeted treatment. Generally “Localisation” of the enlarged gland or glands responsible may be achieved with a combination of Ultrasound scanning, Sestamibi scans, and or 4D CT scans.
How is Hyperparathyroidism treated?
A/Prof McGuinness is an expert in the treatment of hyperparathyoidism. Adenomas or carcinomas are removed surgically. Cases with 4 gland hyperplasia are best treated with removal of 3 ½ glands. Renal Hyperparathyroidism (Secondary or Tertiary) are treated following careful discussion with the treating Renal Physician. Many renal patients will initially be treated with medicines such as Cinacalcet to lower their blood calcium levels.