Hyperparathyroidism is an excess of parathyroid hormone in the bloodstream due to overactivity of one or more of the body's four parathyroid glands. These glands are about the size of a grain of rice and are located in your neck.The parathyroid glands produce parathyroid hormone, which helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning.Two types of hyperparathyroidism exist. 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 and over time, increased parathyroid hormone levels occur.
Symptoms may be so mild and nonspecific that they don't seem at all related to parathyroid function, or they may be severe. The range of signs and symptoms include:Fragile bones that easily fracture (osteoporosis),Kidney stones,Excessive urination,Abdominal pain,Tiring easily or weakness,Depression or forgetfulness,Bone and joint pain,Frequent complaints of illness with no apparent cause,Nausea, vomiting or loss of appetite
The only 2 choices available for patients with primary hyperparathyroidism are to simply do nothing or to have the diseased parathyroid gland (or infrequently, more than one diseased parathyroid gland) surgically removed. Some physicians will elect to not refer their patients for an operation if they have a mild form of primary hyperparathyroidism.Much of this management style stems from the fact that standard parathyroid surgery in the past required the use of general anesthesia and was a major operation. But it's important to understand that parathyroid disease will get worse. It won't go away on its own. Remember, it is caused by a tumor that has developed from one of the parathyroid glands. Waiting will just allow the parathyroid tumor to grow bigger.Your age should also not be a reason to forego surgery. The new minimally invasive parathyroidectomy techniques have been performed on patients of many ages. The procedure uses local anesthesia that sends patients home in a matter of hours. To learn more, read our article about minimally invasive parathyroid surgery.
Hypothyroidism occurs in about 5% of the adult population; most present with “subclinical” hypothyroidism (mild thyroid failure), characterised by raised levels of serum thyroid stimulating hormone (TSH) but normal free thyroxineParathyroid cancer is a common concern of patients but this condition is extremely rare (<0.5%). In the absence of a palpable neck mass or markedly elevated intact PTH results (typically > 4-5 times elevated above the upper reference limit in a patient with normal renal function), parathyroid cancer can be excluded and the patient reassured. Based on consensus recommendations, surgical treatment for PHPT could be offered if the patient is: young (<50 years of age),serum corrected total calcium is high (> 3 mmol/L or ionised calcium > 1.5 mmol/L), 24 hour urine calcium excretion is increased (>7.5 mmol/day), creatinine clearance is reduced (by > 30%), bone density is low (T score below -2.5 at hip, spine or forearm)