Parathyroid Conditions

What are parathyroid glands and what is their function?

Parathyroid glands are small glands that are normally located close to the back of the thyroid gland. Most people have 4 parathyroid glands, two on each side of the neck. In rare cases, people have more than 4 glands, and occasionally parathyroid glands are located in abnormal locations, such as elsewhere in the neck or in the chest. A normal parathyroid gland is about the size of a grain of rice.

Parathyroid glands make a hormone that helps regulate the calcium levels in your body (parathyroid hormone- PTH).

What is hyperparathyroidism?

Hyperparathyroidism refers to an overactivity of the parathyroid glands. As a result, they produce too much parathyroid hormone (PTH), which leads to increased calcium levels in the blood. There are several forms of hyperparathyroidism, some of which are mostly medically managed by endocrinologists or renal physicians. Dr Bell specialises in the surgical treatment of primary hyperparathyroidism.

What is primary hyperparathyroidism?

Primary hyperparathyroidism is a condition in which one or more of the parathyroid glands enlarges and causes overproduction of parathyroid hormone. It is the 3rd most common endocrine condition following diabetes and thyroid conditions. It affects women more than men and is more common in the older population.

What are the symptoms of primary hyperparathyroidism?

Approximately 80% of people with primary hyperparathyroidism have little or no symptoms and the condition is identified as a result of a routine blood test showing increased calcium levels (hypercalcaemia). Symptoms of hypercalcaemia include kidney stones, tiredness, mood changes and memory problems, osteoporosis, renal impairment, abdominal pain and constipation.

What causes primary hyperparathyroidism?

The most common cause of primary hyperparathyroidism is a parathyroid adenoma (benign enlarged parathyroid gland). This is present in 85% of cases. Less common causes are multiple adenomas or 4-gland hyperplasia in which multiple glands are enlarged. Very rarely hyperparathyroidism is caused by a parathyroid cancer.

How is primary hyperparathyroidism diagnosed?

Generally, the first step would be a blood test to check the calcium and parathyroid hormone (PTH) levels, which is usually ordered by your GP.

Dr Bell will take a thorough history and arrange for further testing which may include more blood tests and urinary tests. If the diagnosis is confirmed, Dr Bell will order further investigations to see whether the abnormal gland can be localised. These scans usually include an ultrasound of the neck and a nuclear medicine scan (sestamibi scan). Other scans may include a bone mineral density scan to check for osteoporosis or a 4D CT scan to further localise an abnormal gland if the initial scans are inconclusive.

What is the treatment for primary hyperparathyroidism?

The only potential cure for hyperparathyroidism is surgery. However, not all patients need surgery and sometimes the condition can be managed medically or by close observation. The type of surgery depends on whether one or more glands are affected and whether they can be localised on scans. Surgical management ranges from a minimally invasive parathyroidectomy (MIP) to a 4-gland exploration (bilateral neck exploration). Dr Bell is specialised in parathyroid surgery and will be able to discuss your surgical options with you at your appointment.